Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 3485 | IA |
Y | 207Q00000X | Family Doctor | 3485 | IA |
NPI | 1629029822 |
---|---|
Provider Name | Dr. Sean D Brodale |
First Address | Bloomfield, IA 52537-6803 |
Second Address | Bloomfield, IA 52537-6803 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 22/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
209029206 | (05) | MO |
2424325 | (05) | IA |
H22956 | (02) |