Provider Demographics
NPI:1952365397
Name:BROCK, REBECCA J (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:J
Last Name:BROCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:4999 E KENTUCKY AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-3901
Mailing Address - Country:US
Mailing Address - Phone:303-691-0777
Mailing Address - Fax:303-691-0041
Practice Address - Street 1:4999 E KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-3901
Practice Address - Country:US
Practice Address - Phone:303-691-0777
Practice Address - Fax:303-691-0041
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO32695207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO36321061Medicaid
COCE3428Medicare PIN
CO36321061Medicaid