Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | ME 0083887 | FL |
NPI | 1003808544 |
---|---|
Provider Name | Dr. Craig Michael Brodsky |
First Address | Boca Raton, FL 33486-2268 |
Second Address | Boca Raton, FL 33486-2268 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2005 |
Last Update Date | 18/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
263765100 | (05) | FL |
H59178 | (02) |