Provider Demographics
NPI:1265491450
Name:BROPHY, NATHALIE ANNE (MD)
Entity Type:Individual
Prefix:
First Name:NATHALIE
Middle Name:ANNE
Last Name:BROPHY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 E HAMILTON AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008
Mailing Address - Country:US
Mailing Address - Phone:408-376-2300
Mailing Address - Fax:408-376-2316
Practice Address - Street 1:50 E HAMILTON AVE
Practice Address - Street 2:STE 200
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008
Practice Address - Country:US
Practice Address - Phone:408-376-2300
Practice Address - Fax:408-376-2316
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC41987207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOC419872Medicaid
CAOOC419872Medicare ID - Type Unspecified
CAOOC419872Medicaid
CAZZZ38343ZMedicare ID - Type Unspecified