Klock, George Bradley
Klock, George Bradley is an individual health care provider with primary practice located at 3200 Grand Ave , Des Moines IA 50312-4104. He recently has only one registered license in Allopathic & Osteopathic Physicians / Neuromusculoskeletal Medicine & OMM, which is considered as his primary health care specialty. Klock, George Bradley can be contacted via phone (515) 271-1722.Contact Information
Primary practice address
3200 Grand Ave
Des Moines IA 50312-4104
Phone: (515) 271-1722
Fax: (515) 271-1697
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Neuromusculoskeletal Medicine & OMM | 204D00000X | 1890 | Arizona |
| Allopathic & Osteopathic Physicians / Neuromusculoskeletal Medicine & OMM | 204D00000X | 1998 | Iowa |
Profile Details
| NPI number | 1104810001 |
|---|---|
| LBN Legal business name | Klock, George Bradley |
| Credentials | Doctor of Osteopathy (DO) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 7th, 2005 |
| Last updated | May 23rd, 2012 - about 14 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1104810001 | NPPES |
| Arizona | Other | AZ0064860 | BCBS OF ARIZONA |
| Arizona | MEDICAID | 1104810001 | BCBS OF ARIZONA |
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