Provider Demographics
NPI:1780628081
Name:ROBERT A BROCKMANN MDPC
Entity type:Organization
Organization Name:ROBERT A BROCKMANN MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:BROCKMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-761-4777
Mailing Address - Street 1:3464 S WILLOW ST
Mailing Address - Street 2:SUITE 354
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-4531
Mailing Address - Country:US
Mailing Address - Phone:303-755-2900
Mailing Address - Fax:303-755-0404
Practice Address - Street 1:3345 S LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2925
Practice Address - Country:US
Practice Address - Phone:303-761-4777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO94900868Medicaid
CO94900868Medicaid