| Organization Name: | IRVIN P. BROCK III, M.D., P.A. |
| NPI Number: | 1033145123 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | IRVIN PETE BROCK (PRESIDENT) |
| Mailing Address: | 160 Creekside Park Suite 202 Bulverde |
| State: | TX US |
| Postal Code: | 78163 |
| Phone Number: | 8304384788 |
| Fax Number: | |
| NPI Enumeration Date: | 06/23/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM0850X |
| License Number: | M1535 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Adult Mental Health |
| Taxonomy Definition: | An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults. |