Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | G22557 | CA |
NPI | 1003135930 |
---|---|
Provider Name | Lewis T Broschard |
First Address | Sacramento, CA 95827-2539 |
Second Address | Fairfield, CA 94534-9771 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2010 |
Last Update Date | 03/07/2014 |