Provider Demographics
NPI:1770161549
Name:RICHARDSON, BROCK (MD)
Entity type:Individual
Prefix:
First Name:BROCK
Middle Name:
Last Name:RICHARDSON
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:PO BOX 11407, DEPARTMENT 8007
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-8007
Mailing Address - Country:US
Mailing Address - Phone:205-783-3505
Mailing Address - Fax:205-783-3508
Practice Address - Street 1:817 PRINCETON AVE SW STE 210
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211-1348
Practice Address - Country:US
Practice Address - Phone:205-783-3505
Practice Address - Fax:205-783-3508
Is Sole Proprietor?:No
Enumeration Date:2021-03-31
Last Update Date:2025-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.46610207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine