Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | CH4412 | FL |
NPI | 1942298260 |
---|---|
Provider Name | Dr. Ronald A Brodkin |
First Address | Boca Raton, FL 33432-1614 |
Second Address | Boca Raton, FL 33487-1395 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2005 |
Last Update Date | 27/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
380584100 | (05) | FL |
T85458 | (02) | FL |