Basic Information
| Provider Information | |||||||||
| NPI: | 1427520493 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROCK | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | ALBERT | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3104 BLUE LAKE DR STE 110 | ||||||||
| Address2: | |||||||||
| City: | VESTAVIA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352432372 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059771949 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3104 BLUE LAKE DR STE 110 | ||||||||
| Address2: | |||||||||
| City: | VESTAVIA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352432372 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059771949 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/01/2019 | ||||||||
| LastUpdateDate: | 02/28/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | AC004133 | MD | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 123925 | AL | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.