Provider Demographics
NPI:1740260199
Name:BROUGHER, DAVID E (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:E
Last Name:BROUGHER
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 1:1231 WASHINGTON SQUARE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:41175
Mailing Address - Country:US
Mailing Address - Phone:812-479-6907
Mailing Address - Fax:812-479-6967
Practice Address - Street 1:1231 WASHINGTON SQUARE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:41175
Practice Address - Country:US
Practice Address - Phone:812-479-6907
Practice Address - Fax:812-479-6967
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01036960A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100375500Medicaid
IN000000519145OtherANTHEM BC/BS
1740260199Medicare PIN
IN192750BMedicare ID - Type Unspecified
IN100375500Medicaid