Provider Demographics
NPI:1851337067
Name:BRODBECK, JOEL TODD (DO)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:TODD
Last Name:BRODBECK
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 1:5215 96TH
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-4413
Mailing Address - Country:US
Mailing Address - Phone:806-780-6868
Mailing Address - Fax:806-780-2065
Practice Address - Street 1:5215 96TH
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-4413
Practice Address - Country:US
Practice Address - Phone:806-780-6868
Practice Address - Fax:806-780-2065
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2855208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
87600NMedicare ID - Type Unspecified
G84791Medicare UPIN