Basic Information
| Provider Information | |||||||||
| NPI: | 1336126036 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROCK | ||||||||
| FirstName: | LEE | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8000 W ELDORADO PKWY | ||||||||
| Address2: | BLDG C STE A | ||||||||
| City: | MCKINNEY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750704136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4697429950 | ||||||||
| FaxNumber: | 9725489005 | ||||||||
| Practice Location | |||||||||
| Address1: | 6606 LBJ FWY STE 200 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727155000 | ||||||||
| FaxNumber: | 9727159976 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/23/2005 | ||||||||
| LastUpdateDate: | 02/14/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | H3856 | TX | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 2084P2900X | H3856 | TX | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Pain Medicine | 208VP0014X | H3856 | TX | N | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | 207L00000X | H3856 | TX | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 135571104 | 05 | TX | MEDICAID | 83875K | 01 | TX | BCBS | OTHER | 135577109 | 05 | TX | MEDICAID | 135571103 | 05 | TX | MEDICAID |