Provider Demographics
NPI:1902363203
Name:BARRY J BROCK MD INC.
Entity Type:Organization
Organization Name:BARRY J BROCK MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:JOEL
Authorized Official - Last Name:BROCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-432-6640
Mailing Address - Street 1:421 N RODEO DRIVE
Mailing Address - Street 2:PENTHOUSE 1
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210
Mailing Address - Country:US
Mailing Address - Phone:310-432-6640
Mailing Address - Fax:610-432-6647
Practice Address - Street 1:421 N RODEO DRIVE
Practice Address - Street 2:PENTHOUSE 1
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210
Practice Address - Country:US
Practice Address - Phone:310-432-6640
Practice Address - Fax:610-432-6647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-23
Last Update Date:2019-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty