Active NPI
Disa T. Brock
- Psychiatry Physician
- Provo, UT
National Provider Identifier
1154961746
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 9093412-4408
- Practice address
- 2520 N University Ave # 250a
Provo, UT 84604-3804 - Phone
- (801) 337-8277
- NPI assigned
- Jan 10, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 9093412-4408 | UT | Primary |
Addresses
Primary practice location
2520 N University Ave # 250a
Provo, UT 84604-3804
Mailing address
1211 E 2080 N
Provo, UT 84604-2147
Phone (801) 753-5543
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9093412-4408 | UT | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1578614400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1578614400000",
"number": "1154961746",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1211 E 2080 N",
"city": "PROVO",
"state": "UT",
"postal_code": "846042147",
"telephone_number": "801-753-5543"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2520 N UNIVERSITY AVE # 250A",
"city": "PROVO",
"state": "UT",
"postal_code": "846043804",
"telephone_number": "801-337-8277"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROCK",
"first_name": "DISA",
"middle_name": "T.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-01-10",
"last_updated": "2020-01-10",
"certification_date": "2020-01-10",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "UT",
"license": "9093412-4408",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Provo, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.