NPI 1417210279

Jonathan William Ceral Brock, MDPHD

Practitioner Pediatrics Physician West Columbia, SC

Practice location

Address: 2318a Sunset Blvd, West Columbia, SC 29169-4716
Phone: (803) 796-9200
Fax: (803) 462-0312
Mailing address: 601 Clemson Rd, Columbia, SC 29229-4341

Registered specialties

Pediatrics Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 208000000X Licence MD34729 (SC)

Other Pediatrics providers in South Carolina →

Registry record

NPI: 1417210279
Entity type: Individual
Sex (as registered): Male
NPI issued: 18 Jun 2012
Record last updated: 15 Jul 2019

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.