Provider Demographics
NPI:1497983274
Name:BRODSKY, RENATA (DO)
Entity Type:Individual
Prefix:
First Name:RENATA
Middle Name:
Last Name:BRODSKY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4351 E LOHMAN AVE STE 320
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8262
Mailing Address - Country:US
Mailing Address - Phone:575-522-4940
Mailing Address - Fax:575-522-4932
Practice Address - Street 1:4351 E LOHMAN AVE STE 320
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8262
Practice Address - Country:US
Practice Address - Phone:575-522-4940
Practice Address - Fax:575-522-4932
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMA-2223-19208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery