Provider Demographics
NPI:1801889183
Name:BRODIE, ROBERT WRIGHT (PA C)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:WRIGHT
Last Name:BRODIE
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Gender:M
Credentials:PA C
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Mailing Address - Street 1:206 HOSPITAL LN
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PERRYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63775-1276
Mailing Address - Country:US
Mailing Address - Phone:573-768-3396
Mailing Address - Fax:573-768-3397
Practice Address - Street 1:206 HOSPITAL LN
Practice Address - Street 2:SUITE 202
Practice Address - City:PERRYVILLE
Practice Address - State:MO
Practice Address - Zip Code:63775-1276
Practice Address - Country:US
Practice Address - Phone:573-768-3396
Practice Address - Fax:573-768-3397
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2012-03-29
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Provider Licenses
StateLicense IDTaxonomies
MO2001023599363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant