Provider Demographics
NPI:1518255751
Name:BROCKWELL, MATTHEW JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JAMES
Last Name:BROCKWELL
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 1:2323 SACRAMENTO ST
Mailing Address - Street 2:OUTPATIENT CLINIC, 2ND FLOOR
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-2328
Mailing Address - Country:US
Mailing Address - Phone:415-600-5802
Mailing Address - Fax:
Practice Address - Street 1:2323 SACRAMENTO ST
Practice Address - Street 2:OUTPATIENT CLINIC, 2ND FLOOR
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2328
Practice Address - Country:US
Practice Address - Phone:415-600-5802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-20
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1173002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry