Brockenbrough, John M

Brockenbrough, John M is an individual health care provider with primary practice located at 12303 Ne 130Th Ln Ste 400 , Kirkland WA 98034-3041. He recently has only one registered license in Allopathic & Osteopathic Physicians / Otolaryngology, which is considered as his primary health care specialty. Brockenbrough, John M can be contacted via phone (425) 899-4590.

Contact Information

Primary practice address
12303 Ne 130Th Ln Ste 400 Kirkland WA 98034-3041
Phone: (425) 899-4590
Fax: (425) 899-4591
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Otolaryngology 207Y00000X 036101927 Illinois

Profile Details

NPI number 1134154131
LBN Legal business name Brockenbrough, John M
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 11th, 2006
Last updated Dec 12th, 2017 - about 7 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 1134154131 NPPES
Illinois MEDICAID 6447860011

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