David Wesley Brock, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

6725565-1206 Issued in UT

Practice address

3550 N University Ave
Suite 250
Provo, UT 84604-6683

Phone

(801) 374-9625

Fax

(801) 374-9690

NPI assigned

Oct 4, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1191456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1455062400000",
    "number": "1205024122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 N MARIO CAPECCHI DR",
            "address_2": "SUITE 250",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841131103",
            "telephone_number": "801-662-5582"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3550 N UNIVERSITY AVE",
            "address_2": "SUITE 250",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846046683",
            "telephone_number": "801-374-9625",
            "fax_number": "801-374-9690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROCK",
        "first_name": "DAVID",
        "middle_name": "WESLEY",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-10-04",
        "last_updated": "2016-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "UT",
            "license": "6725565-1206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paul W Broadbent, MD
• Cassie K Broadhead, PA-C
• Lauren Broadhead
• Jeffrey Charles Broberg, M.D.
• Kathryn Larue Broberg
• Disa T. Brock
• David Thomas Brockbank, MD
• Luke McKell Brockbank, MD
• Clara Susanne Broderick, SSW
• Summer Alyse Broeker

• Surgical Physician Assistant in Provo, UT
• Providers in Provo, UT by specialty
• Surgical Physician Assistant in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 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.