Provider Demographics
NPI:1851426324
Name:BROSTROM, RICHARD JAMES (MD MSPH)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JAMES
Last Name:BROSTROM
Suffix:
Gender:M
Credentials:MD MSPH
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 10001
Mailing Address - Street 2:PMB 631
Mailing Address - City:SAIPAN
Mailing Address - State:MP
Mailing Address - Zip Code:96950
Mailing Address - Country:US
Mailing Address - Phone:670-322-3773
Mailing Address - Fax:670-236-8700
Practice Address - Street 1:COMMONWEALTH HEALTH CENTER
Practice Address - Street 2:1 LOWER MARY HILL ROAD
Practice Address - City:SAIPAN
Practice Address - State:MP
Practice Address - Zip Code:96950
Practice Address - Country:US
Practice Address - Phone:670-234-8950
Practice Address - Fax:670-236-8700
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MPMP-0192207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G86732Medicare UPIN