Provider Demographics
NPI:1952603565
Name:DAVID M. BRODERICK, M.D., INC.
Entity Type:Organization
Organization Name:DAVID M. BRODERICK, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGERY SCHEDULER
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SAETERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-925-8111
Mailing Address - Street 1:107 SCRIPPS DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-6300
Mailing Address - Country:US
Mailing Address - Phone:916-925-8111
Mailing Address - Fax:916-925-8136
Practice Address - Street 1:107 SCRIPPS DR STE 200
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-6300
Practice Address - Country:US
Practice Address - Phone:916-925-8111
Practice Address - Fax:916-925-8136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC042099207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C420990Medicare Oscar/Certification
CAA37744Medicare UPIN