Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | ME39994 | FL |
N | 111NI0900X | Internist | ME39994 | FL |
N | 207RH0002X | Hospice and Palliative Medicine | ME39994 | FL |
Y | 207RP1001X | Pulmonary Disease | ME39994 | FL |
NPI | 1376571893 |
---|---|
Provider Name | John Michael Brodnan |
First Address | Belfast, ME 04915-4005 |
Second Address | Rockledge, FL 32955-2827 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2006 |
Last Update Date | 18/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
068442200 | (05) | FL |
D63172 | (02) | FL |