Provider Demographics
NPI:1598762692
Name:LIDEN, BROCK ARMSTRONG (DPM)
Entity Type:Individual
Prefix:
First Name:BROCK
Middle Name:ARMSTRONG
Last Name:LIDEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 693
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-0693
Mailing Address - Country:US
Mailing Address - Phone:740-474-3850
Mailing Address - Fax:
Practice Address - Street 1:210 SHARON RD STE A
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-1498
Practice Address - Country:US
Practice Address - Phone:740-474-3850
Practice Address - Fax:888-821-9123
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-00-3103-L213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7887840001OtherNATIONAL SUPPLIER CLEARINGHOUSE
OH2095281Medicaid
P00287259OtherRR MEDICARE R PIN
OH02861511Medicare ID - Type UnspecifiedOHIO MEDICARE NUMBER
OH2095281Medicaid
OH5616730001Medicare NSC
OH0861513Medicare ID - Type UnspecifiedOHIO MEDICARE NUMBER
OH5620650001Medicare NSC
P00287259OtherRR MEDICARE R PIN