Robert J Brock MD PA

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

M7908 Issued in ID

Legal business name

ROBERT J BROCK MD PA

Practice address

2420 East 25TH Circle
Suite B
Idaho Falls, ID 83404-7549

Phone

(208) 525-3220

Fax

(208) 525-3227

NPI assigned

Feb 7, 2007

Organization subpart

No

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

Authorized official

Name

Robert J Brock, M.D.

Title

President

Phone

(208) 525-3220

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Vanessa K French, PA-C

  • Physician Assistant
  • Idaho Falls, ID
  • NPI 1588851984
  NPD (past)
• Darin Leslie, PA-C

  • Medical Physician Assistant
  • Idaho Falls, ID
  • NPI 1477608099
  NPD (past)

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

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196640000000",
    "number": "1972643997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3070",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834033070",
            "telephone_number": "208-525-3220",
            "fax_number": "208-525-3227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2420 EAST 25TH CIRCLE",
            "address_2": "SUITE B",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047549",
            "telephone_number": "208-525-3220",
            "fax_number": "208-525-3227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBERT J BROCK MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-07",
        "last_updated": "2007-12-03",
        "status": "A",
        "authorized_official_last_name": "BROCK",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-525-3220",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "ID",
            "license": "M7908",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8055716000",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Robert J. Lee, M.D., PC
• Eric Deloy Roberts, MSPT
• Jacob Benjamin Roberts, DPT
• Jane C Roberts, MS, SLP-CCC
• Jared Roberts

• Psychiatry Physician in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Psychiatry Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2007; 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.