Provider Demographics
NPI:1619086485
Name:BROM, DIRK HOVEY (MD)
Entity Type:Individual
Prefix:DR
First Name:DIRK
Middle Name:HOVEY
Last Name:BROM
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 1:3320 FOXLEY DR
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-1110
Mailing Address - Country:US
Mailing Address - Phone:515-296-4817
Mailing Address - Fax:515-296-4817
Practice Address - Street 1:3600 30TH ST
Practice Address - Street 2:DEPARTMENT OF SURGERY
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-5753
Practice Address - Country:US
Practice Address - Phone:515-699-5999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA22031207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology