Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | 45293 | GA |
N | 207VX0201X | Gynecologic Oncologist | 9247 | HI |
NPI | 1568439768 |
---|---|
Provider Name | Dr. John Warren Mcbroom |
First Address | Atlanta, GA 30318-2538 |
Second Address | Atlanta, GA 30318-2538 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2006 |
Last Update Date | 24/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003103996D | (05) | GA |
003103996F | (05) | GA |