Provider Demographics
NPI:1326033879
Name:BROCKMAN, STEVEN K (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:K
Last Name:BROCKMAN
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 YANCEY ST
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-3672
Mailing Address - Country:US
Mailing Address - Phone:704-481-7713
Mailing Address - Fax:704-235-1971
Practice Address - Street 1:1112 YANCEY ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3672
Practice Address - Country:US
Practice Address - Phone:704-481-7713
Practice Address - Fax:704-235-1971
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33212208VP0000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1982129136Medicaid
NC211832BMedicare PIN
NCD92669Medicare UPIN