Provider Demographics
NPI:1033112461
Name:BROTMAN, DAVID NEIL (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:NEIL
Last Name:BROTMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1000 W KINGSHIGHWAY STE 14
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-4197
Mailing Address - Country:US
Mailing Address - Phone:870-239-8591
Mailing Address - Fax:870-239-8137
Practice Address - Street 1:1000 W. KINGSHIGHWAY
Practice Address - Street 2:SUITE 13
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450
Practice Address - Country:US
Practice Address - Phone:870-239-8107
Practice Address - Fax:870-239-8115
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2012034742208600000X
ARE-11201208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR196413001Medicaid
PAF54183Medicare UPIN