| Jay David Brock, MD, PC | |
|
4304 Lafayette Blvd Fredericksburg VA 22408-4234 | |
| (540) 891-5600 | |
| (540) 891-9034 |
| Full Name | Jay David Brock, MD, PC |
|---|---|
| Speciality | Family Medicine |
| Location | 4304 Lafayette Blvd, Fredericksburg, Virginia |
| Authorized Official Name and Position | Jay D. Brock (PHYSICIAN) |
| Authorized Official Contact | 5408915600 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jay David Brock, MD, PC 4304 Lafayette Blvd Fredericksburg VA 22408-4234 Ph: (540) 891-5600 | Jay David Brock, MD, PC 4304 Lafayette Blvd Fredericksburg VA 22408-4234 Ph: (540) 891-5600 |
| NPI Number | 1053359968 |
|---|---|
| Provider Enumeration Date | 06/03/2006 |
| Last Update Date | 05/03/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053359968 | NPI | - | NPPES |
| 5690803 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 0101032059 (Virginia) | Primary |
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