Provider Demographics
NPI:1467446831
Name:BRODAR, FRANC W
Entity Type:Individual
Prefix:
First Name:FRANC
Middle Name:W
Last Name:BRODAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22815 N 38TH WAY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050
Mailing Address - Country:US
Mailing Address - Phone:602-619-3282
Mailing Address - Fax:
Practice Address - Street 1:22815 N 38 WAY
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050
Practice Address - Country:US
Practice Address - Phone:602-619-3282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24079207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ390021Medicaid
61655Medicare ID - Type Unspecified
G51845Medicare UPIN