Provider Demographics
NPI:1508435322
Name:BRODAR, STEVEN CANON (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:CANON
Last Name:BRODAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 ROBINHOOD MEDICAL PLZ
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-5472
Practice Address - Country:US
Practice Address - Phone:336-718-0800
Practice Address - Fax:336-718-0871
Is Sole Proprietor?:No
Enumeration Date:2021-06-24
Last Update Date:2024-08-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0116035585207Q00000X
NC2024-00459207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine