JONATHAN WILLIAM CERAL BROCK (NPI# 1417210279) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417210279 |
| Entity Type | Individual |
| Full Name | JONATHAN WILLIAM CERAL BROCK |
| Credential | MD, PHD |
| Practice Address |
2318a Sunset Blvd West Columbia SC 29169-4716 |
| Mailing Address |
601 Clemson Rd Columbia SC 29229-4341 |
| Practice Telephone | 8037969200 |
| Practice Fax Number | 8034620312 |
| Mailing Telephone | 8037886146 |
| Mailing Fax Number | 8034620312 |
| Enumeration Date | 2012-06-18 |
| Last Update Date | 2019-07-15 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | MD34729 | SC | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871927269 | Jonathan Russell Brock | Student in an Organized Health Care Education/Training Program | 1 Medical Center Blvd, Winston Salem, NC 27157-0001 | 2013-08-21 |
| Street Address |
2318A SUNSET BLVD |
| City | WEST COLUMBIA |
| State | SC |
| Zip Code | 29169-4716 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780884700 | Alicia Dawkins Mcfarland | Pediatrics | 2318a Sunset Blvd, West Columbia, SC 29169-4716 | 2007-07-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457960726 | Jerry Scott Oreilly | Physical Therapy Assistant | 100 Dreher Rd, Suite 100, West Columbia, SC 29169 | 2020-07-23 |
| 1134759921 | A&m Medical, LLC | Durable Medical Equipment & Medical Supplies | 1053 Sunset Boulevard, West Columbia, SC 29169 | 2020-01-21 |
| 1750946067 | First Physical Therapy, LLC | Clinic/Center | 100 Dreher Rd., Suite 100, West Columbia, SC 29169 | 2019-05-02 |
| 1295217545 | Tynaka Kwans Wilson | Nurse Practitioner | Sc House Calls Inc, 1053 Center Street, West Columbia, SC 29169 | 2018-09-04 |
| 1588183826 | Kimberly Jane Jennings | Registered Nurse | 1052 Center Street, Sc House Calls Inc, West Columbia, SC 29169 | 2017-09-19 |
| 1164943213 | Jacob Luke Wayland | Emergency Medicine | Lexington Medical Center-emergency Medicine Dept, 2720 Sunset Blvd, West Columbia, SC 29169 | 2017-06-29 |
| 1740721232 | Heather Detwiler | Physical Therapy Assistant | 2705 Leaphart Rd., Carolina Gardens, West Columbia, SC 29169 | 2017-03-16 |
| 1588110761 | Virginia I Hall | Nurse Practitioner | 2720 Susnet Blvd, West Columbia, SC 29169 | 2016-08-29 |
| 1215395744 | Stacey Khalifa | Social Worker | 160 Medical Cir Fl 1, West Columbia, SC 29169 | 2016-01-28 |
| 1407252331 | Sandy Frye Boone | Counselor | 2318 Sunset Blvd # 2a, West Columbia, SC 29169 | 2014-11-04 |
| Find all providers in zip 29169 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144482035 | Monica S Mccutcheon | Pediatrics | 3573 Sunset Blvd, West Columbia, SC 29169-3043 | 2008-07-01 |
| 1780884700 | Alicia Dawkins Mcfarland | Pediatrics | 2318a Sunset Blvd, West Columbia, SC 29169-4716 | 2007-07-18 |
| 1679697452 | Carryn Nacia Rice | Pediatrics | 500 N 12th St, West Columbia, SC 29169-6502 | 2007-03-19 |
| 1194737122 | Larry C Smith II | Pediatrics | 172 Mcswain Drive, Suite A, West Columbia, SC 29169 | 2006-08-11 |
| 1588674667 | The Kids Group | Pediatrics | 206 Medical Circle, Suite 1b, West Columbia, SC 29169 | 2006-08-09 |
| 1457328932 | Ronnie W Neuberg | Pediatrics | 112 Saluda Ridge Ct Ste 200, West Columbia, SC 29169-3461 | 2006-03-03 |
| 1003255605 | Sara Kathleen Sheehan | Pediatrics | 3240 Sunset Blvd, West Columbia, SC 29169-3428 | 2013-06-18 |
| 1194163832 | Aprel Samantha Barnes | Pediatrics | 500 N 12th St, West Columbia, SC 29169-6502 | 2013-06-04 |
| 1578855805 | Lexington County Health Services District, Inc. | Pediatrics | 3240 Sunset Blvd, West Columbia, SC 29169 | 2011-05-04 |
| 1124330139 | Amanda Lynn Goodno | Pediatrics | 500 N 12th St, West Columbia, SC 29169-6502 | 2010-07-07 |
| Find all providers in WEST COLUMBIA | ||||
| City | WEST COLUMBIA |
| Zip Code | 29169 |
Please comment or provide details below to improve the information on JONATHAN WILLIAM CERAL BROCK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.