Provider Demographics
NPI:1346213394
Name:BROCKWAY, STEPHEN KEITH (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:KEITH
Last Name:BROCKWAY
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 1:2340 CLAY ST FL 7
Mailing Address - Street 2:CALIFORNIA PACIFIC MEDICAL CENTER
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-1932
Mailing Address - Country:US
Mailing Address - Phone:415-600-5739
Mailing Address - Fax:
Practice Address - Street 1:2340 CLAY ST FL 7
Practice Address - Street 2:CALIFORNIA PACIFIC MEDICAL CENTER
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-1932
Practice Address - Country:US
Practice Address - Phone:415-600-5739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA812232084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A812230Medicaid
CA00A812231Medicare PIN
CAI15708Medicare UPIN