Broadnax, Jeremy Phillippe

Broadnax, Jeremy Phillippe is an individual health care provider with primary practice located at 1229 E Seminole St Ste 320, Springfield MO 65804. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Anesthesiology, Allopathic & Osteopathic Physicians / Pain Medicine. Allopathic & Osteopathic Physicians / Pain Medicine is his primary health care specialty. Broadnax, Jeremy Phillippe can be contacted via phone (417) 820-2064.

Contact Information

Primary practice address
1229 E Seminole St Ste 320 Springfield MO 65804
Phone: (417) 820-2064
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Anesthesiology 207L00000X 2013031744 Missouri
Allopathic & Osteopathic Physicians / Pain Medicine 207LP2900X 2013031744 Missouri

Profile Details

NPI number 1326204611
LBN Legal business name Broadnax, Jeremy Phillippe
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 6th, 2008
Last updated Aug 1st, 2019 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1326204611 NPPES
Arkansas MEDICAID 200332001
Arkansas Other 431560263
Arkansas MEDICAID 1326204611
Arkansas Other P01246688

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