Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | ML20008983 | WA |
N | 208600000X | Surgeon | ML20008983 | WA |
Y | 2086S0120X | Pediatric Surgery | 267531 | MA |
NPI | 1649463555 |
---|---|
Provider Name | Rebecca Brocks |
First Address | Springfield, MA 01199-0001 |
Second Address | Springfield, MA 01107-1381 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2007 |
Last Update Date | 18/07/2016 |