Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213ES0131X | Foot Surgery | DP 00375 | OR |
N | 213ES0131X | Foot Surgery | POD.0000831 | CO |
Y | 213ES0131X | Foot Surgery | POD417 | NM |
NPI | 1215011218 |
---|---|
Provider Name | Bryan Kent Broadbent |
First Address | Farmington, NM 87401-8991 |
Second Address | Farmington, NM 87401-8991 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 01/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10432353 | (05) | NM |