Provider Demographics
NPI:1083722094
Name:BROCHARD, VICTOR ALBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:ALBERT
Last Name:BROCHARD
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 1:1951 CORTEREAL AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-2631
Mailing Address - Country:US
Mailing Address - Phone:510-339-1912
Mailing Address - Fax:
Practice Address - Street 1:1951 CORTEREAL AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-2631
Practice Address - Country:US
Practice Address - Phone:510-339-1912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A23595174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
A86680Medicare UPIN