Provider Demographics
NPI:1881790657
Name:BROCK, BOBBY CHARLES (MD)
Entity type:Individual
Prefix:MR
First Name:BOBBY
Middle Name:CHARLES
Last Name:BROCK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8711 VILLAGE DR STE 114
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5419
Mailing Address - Country:US
Mailing Address - Phone:830-743-9192
Mailing Address - Fax:830-743-9193
Practice Address - Street 1:66 GRUENE PARK DR STE 205
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130
Practice Address - Country:US
Practice Address - Phone:830-743-9192
Practice Address - Fax:830-743-9193
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2018-05-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXH5753207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH5753OtherTX LICENSE
TXPO1477395OtherRR MEDICARE
TX139144317Medicaid
TXPO1477395OtherRR MEDICARE