Provider Demographics
NPI:1942299342
Name:BROUETTE, RICHARD J (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:BROUETTE
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 1:426 PARKVIEW AVE STE 1400
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95993-5232
Mailing Address - Country:US
Mailing Address - Phone:306-829-6405
Mailing Address - Fax:530-751-9826
Practice Address - Street 1:426 PARKVIEW AVE
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95993-5232
Practice Address - Country:US
Practice Address - Phone:530-682-9640
Practice Address - Fax:530-751-9826
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG069457207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G694570Medicaid
F78434Medicare UPIN
CA00G694570Medicare ID - Type Unspecified