Provider Demographics
NPI:1720492358
Name:BROTHERSON, BOBBIE (DO)
Entity Type:Individual
Prefix:
First Name:BOBBIE
Middle Name:
Last Name:BROTHERSON
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 1:2314 SASSAFRAS ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-2722
Mailing Address - Country:US
Mailing Address - Phone:814-452-5109
Mailing Address - Fax:
Practice Address - Street 1:2314 SASSAFRAS ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-2722
Practice Address - Country:US
Practice Address - Phone:814-452-5109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-11
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT016040207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty