Dale W Brock

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

603165 Issued in TX

Legal business name

DALE W BROCK

Doing business as

Trinity Valley Clinic

Practice address

2800 Beaumont Ave
Suite a
Liberty, TX 77575-5126

Phone

(936) 336-3100

Fax

(936) 336-3102

NPI assigned

May 23, 2016

Last updated

May 23, 2016By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dale W Brock, APNNPI 1922055292

Title

Owner

Phone

(936) 336-3100

Specialties & licenses 1

Addresses

Other names 1

• Trinity Valley Clinic Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Dale Wayne Brock, APN

  • Nurse Practitioner
  • Winnie, TX
  • NPI 1922055292
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1463961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463961600000",
    "number": "1013364710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2800 BEAUMONT AVE",
            "address_2": "SUITE A",
            "city": "LIBERTY",
            "state": "TX",
            "postal_code": "775755126",
            "telephone_number": "936-336-3100",
            "fax_number": "936-336-3102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2800 BEAUMONT AVE",
            "address_2": "SUITE A",
            "city": "LIBERTY",
            "state": "TX",
            "postal_code": "775755126",
            "telephone_number": "936-336-3100",
            "fax_number": "936-336-3102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DALE W BROCK",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-23",
        "last_updated": "2016-05-23",
        "status": "A",
        "authorized_official_last_name": "BROCK",
        "authorized_official_first_name": "DALE",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "936-336-3100",
        "authorized_official_credential": "APN"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "603165",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Trinity Valley Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Nurse Practitioner in Liberty, TX
• Providers in Liberty, TX by specialty
• Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.