Provider Demographics
NPI:1033169339
Name:BROCHERT, ADAM JAMES (MD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:JAMES
Last Name:BROCHERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 EISENHOWER DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-2668
Mailing Address - Country:US
Mailing Address - Phone:912-355-6255
Mailing Address - Fax:912-355-6256
Practice Address - Street 1:74785 US HIGHWAY 111 STE 101
Practice Address - Street 2:
Practice Address - City:INDIAN WELLS
Practice Address - State:CA
Practice Address - Zip Code:92210
Practice Address - Country:US
Practice Address - Phone:760-836-3835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA922442085R0202X
GA0521472085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A922440Medicaid
CA00A922440OtherBLUE SHIELD OF CA
CA00A922440Medicaid
CA00A922440Medicare PIN
CA00A922440OtherBLUE SHIELD OF CA