Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Brock C Street, PA-C

Individual provider Surgical Physician Assistant · NPI 1043759731

Brock C Street, PA-C is a Physician Assistant in Fort Worth, Texas. Qualified in 2016, 10 years ago. Practices with Cook Childrens Physician Network, a 301-clinician group and accepts Medicare assignment. Licensed in Texas.

Years since qualifying
10
Licensed in
TX
In the registry since
2017
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

1500 Cooper St
Fort Worth, TX 76104-2710
Phone: (682) 885-7080
Fax: (682) 885-7085
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA11072 (TX)
Surgical Physician Assistant Taxonomy 363AS0400X · Licence PA11072 (TX)

Record details

NPI number1043759731
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedFebruary 15, 2017
Last updated in NPPESApril 6, 2023
Certification dateApril 6, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2016 (10 years in practice)
Group practice Cook Childrens Physician Network — 301 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

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