Provider Demographics
NPI:1144649138
Name:ALONZO, BROCK (MD)
Entity type:Individual
Prefix:
First Name:BROCK
Middle Name:
Last Name:ALONZO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 N 10TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-5322
Mailing Address - Country:US
Mailing Address - Phone:406-363-5434
Mailing Address - Fax:406-363-5210
Practice Address - Street 1:300 N 10TH ST STE A
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-5322
Practice Address - Country:US
Practice Address - Phone:406-363-5434
Practice Address - Fax:406-363-5210
Is Sole Proprietor?:No
Enumeration Date:2014-04-07
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT77900207WX0009X, 207WX0009X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist