Provider Demographics
NPI:1669643052
Name:BROCKMAN, DAVID DANIEL (PA)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:DANIEL
Last Name:BROCKMAN
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Gender:M
Credentials:PA
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Mailing Address - Street 1:2 MEDICAL PLAZA DR
Mailing Address - Street 2:SUITE # 175
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3043
Mailing Address - Country:US
Mailing Address - Phone:916-782-2146
Mailing Address - Fax:916-782-4299
Practice Address - Street 1:2 MEDICAL PLAZA DR
Practice Address - Street 2:#175
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3043
Practice Address - Country:US
Practice Address - Phone:916-782-2146
Practice Address - Fax:916-782-4299
Is Sole Proprietor?:No
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
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Provider Licenses
StateLicense IDTaxonomies
CA14472207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS47897Medicare UPIN