Brockett, Ted

Brockett, Ted is an individual health care provider with primary practice located at 3200 Canyon Lake Dr , Rapid City SD 57702-8114. He recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medicine, which is considered as his primary health care specialty. Brockett, Ted can be contacted via phone (605) 355-2500.

Contact Information

Primary practice address
3200 Canyon Lake Dr Rapid City SD 57702-8114
Phone: (605) 355-2500
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 030436 Georgia

Profile Details

NPI number 1760440408
LBN Legal business name Brockett, Ted
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 3rd, 2006
Last updated Jul 9th, 2007 - about 17 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 1760440408 NPPES
Georgia MEDICAID 00406766M
Georgia MEDICAID 790611N

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