Provider Demographics
NPI:1790348811
Name:HARDING, BROCK (MD)
Entity Type:Individual
Prefix:
First Name:BROCK
Middle Name:
Last Name:HARDING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 SATORI PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-6407
Mailing Address - Country:US
Mailing Address - Phone:317-271-6363
Mailing Address - Fax:317-271-7600
Practice Address - Street 1:301 SATORI PKWY STE 200
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-6407
Practice Address - Country:US
Practice Address - Phone:317-271-6363
Practice Address - Fax:317-271-7600
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-15
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN390200000X
IN01088304A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program