Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 080560 | GA |
Y | 111NI0900X | Internist | 080560 | GA |
N | 207R00000X | Internist | 7539 | GA |
N | 111NI0900X | Internist | 7539 | GA |
NPI | 1003298902 |
---|---|
Provider Name | Dr. Bryan Richard Broach |
First Address | Augusta, GA 30912-0004 |
Second Address | Augusta, GA 30912 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2015 |
Last Update Date | 10/07/2018 |