Provider Demographics
NPI:1003135930
Name:BROSCHARD, LEWIS T (MD)
Entity Type:Individual
Prefix:
First Name:LEWIS
Middle Name:T
Last Name:BROSCHARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:707-427-4900
Mailing Address - Fax:707-428-2740
Practice Address - Street 1:2720 LOW CT
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-9771
Practice Address - Country:US
Practice Address - Phone:707-864-0356
Practice Address - Fax:707-428-2740
Is Sole Proprietor?:No
Enumeration Date:2010-05-17
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG22557208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1003135930Medicare PIN