Provider Demographics
NPI:1609902550
Name:BROKKE, JAMES D (DO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:D
Last Name:BROKKE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 S JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:EXIRA
Mailing Address - State:IA
Mailing Address - Zip Code:50076-7726
Mailing Address - Country:US
Mailing Address - Phone:712-268-5348
Mailing Address - Fax:712-268-2145
Practice Address - Street 1:107 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:EXIRA
Practice Address - State:IA
Practice Address - Zip Code:50076-7726
Practice Address - Country:US
Practice Address - Phone:712-268-5348
Practice Address - Fax:712-268-2145
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03146207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA3176438Medicaid
IAI17126Medicare ID - Type Unspecified
IAG74670Medicare UPIN