Provider Demographics
NPI:1417921057
Name:BROCKMAN, JAMES THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:THOMAS
Last Name:BROCKMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9582 PRINCETON GLENDALE RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-9709
Mailing Address - Country:US
Mailing Address - Phone:513-346-5640
Mailing Address - Fax:513-346-5644
Practice Address - Street 1:9582 PRINCETON GLENDALE RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-9709
Practice Address - Country:US
Practice Address - Phone:513-346-5640
Practice Address - Fax:513-346-5644
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35055812B207Q00000X
OH35055812207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0928992Medicaid
OH0928992Medicaid
OHE29653Medicare UPIN