Provider Demographics
NPI:1144851122
Name:BROCK PAIN MEDICINE AND ANESTHESIA
Entity type:Organization
Organization Name:BROCK PAIN MEDICINE AND ANESTHESIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:FROBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-742-9950
Mailing Address - Street 1:8000 ELDORADO PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-4136
Mailing Address - Country:US
Mailing Address - Phone:469-742-9950
Mailing Address - Fax:972-548-9005
Practice Address - Street 1:8000 ELDORADO PKWY STE A
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-4136
Practice Address - Country:US
Practice Address - Phone:469-742-9950
Practice Address - Fax:972-548-9005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty