Provider Demographics
NPI:1740213875
Name:BROCK, REBECCA J (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:J
Last Name:BROCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:737 W CHILDS AVE
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95341-6805
Mailing Address - Country:US
Mailing Address - Phone:209-383-1848
Mailing Address - Fax:209-383-1296
Practice Address - Street 1:1500 FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4408
Practice Address - Country:US
Practice Address - Phone:209-574-1030
Practice Address - Fax:209-574-2853
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG064149207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00G641491Medicare ID - Type Unspecified
CAE99859Medicare UPIN