Provider Demographics
NPI:1336361500
Name:BRODER, HOWARD J (MD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:J
Last Name:BRODER
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 1:6355 S BUFFALO DR FL 3
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-2133
Mailing Address - Country:US
Mailing Address - Phone:702-216-3346
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:2865 SIENA HEIGHTS DR
Practice Address - Street 2:SUITE 331
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4167
Practice Address - Country:US
Practice Address - Phone:702-731-8224
Practice Address - Fax:702-990-8757
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV13134207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1336361500Medicaid
NVCF823YMedicare PIN
NVCF823XMedicare PIN