Provider Demographics
NPI:1659390219
Name:BROECKEL, WILLIAM F (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:F
Last Name:BROECKEL
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 1:475 BRUCE ST
Mailing Address - Street 2:
Mailing Address - City:YREKA
Mailing Address - State:CA
Mailing Address - Zip Code:96097-3474
Mailing Address - Country:US
Mailing Address - Phone:530-841-4980
Mailing Address - Fax:530-841-4979
Practice Address - Street 1:475 BRUCE ST
Practice Address - Street 2:
Practice Address - City:YREKA
Practice Address - State:CA
Practice Address - Zip Code:96097-3474
Practice Address - Country:US
Practice Address - Phone:530-841-4980
Practice Address - Fax:530-841-4979
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG53319208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G53319Medicaid
CARHM53948FMedicaid
CARHM53948FMedicaid