Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 342621-1205 | UT |
N | 207XS0117X | Orthopaedic Spine Surgeon | 342621-1205 | UT |
NPI | 1407800311 |
---|---|
Provider Name | Darrel Scott Brodke |
First Address | Slc, UT 84141-3067 |
Second Address | Salt Lake City, UT 84108-1200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2006 |
Last Update Date | 11/11/2021 |