Provider Demographics
NPI:1114152550
Name:ROBERT T. BROUILLETTE, M.D., INC.
Entity Type:Organization
Organization Name:ROBERT T. BROUILLETTE, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:WICHMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-351-2227
Mailing Address - Street 1:2001 UNION ST STE 495
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123-4128
Mailing Address - Country:US
Mailing Address - Phone:415-351-2227
Mailing Address - Fax:
Practice Address - Street 1:2001 UNION ST STE 495
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94123-4128
Practice Address - Country:US
Practice Address - Phone:415-351-2227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty