Provider Demographics
NPI:1649589904
Name:BROCK, SYLVIA EUNICE
Entity Type:Individual
Prefix:DR
First Name:SYLVIA
Middle Name:EUNICE
Last Name:BROCK
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:SYLVIA
Other - Middle Name:EUNICE
Other - Last Name:BROCK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3302 MOUNTAINVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHEWELAH
Mailing Address - State:WA
Mailing Address - Zip Code:99109-9642
Mailing Address - Country:US
Mailing Address - Phone:509-675-0758
Mailing Address - Fax:
Practice Address - Street 1:3302 MOUNTAINVIEW RD
Practice Address - Street 2:
Practice Address - City:CHEWELAH
Practice Address - State:WA
Practice Address - Zip Code:99109-9642
Practice Address - Country:US
Practice Address - Phone:509-675-0758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-04
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA16251208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice