Provider Demographics
NPI:1932213139
Name:BROCKENBROUGH, JAMES ALBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ALBERT
Last Name:BROCKENBROUGH
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 1:3210 MERSINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64128-2143
Mailing Address - Country:US
Mailing Address - Phone:816-813-8308
Mailing Address - Fax:816-924-3223
Practice Address - Street 1:21 N 12TH ST STE 103A
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66102-5161
Practice Address - Country:US
Practice Address - Phone:816-531-0110
Practice Address - Fax:816-531-0115
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC35494208G00000X
MO2009015153208G00000X
KS32320208G00000X
GA015451208D00000X
MDD21650208600000X
PAMD021740E208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA4214001Medicare PIN
KSKA2719001Medicare PIN
KSKA3416001Medicare PIN
MOMA4235001Medicare PIN