Broder, Kevin Wayne
Broder, Kevin Wayne is an sole proprietor health care provider with primary practice located at 4510 Executive Drive Suite 200, San Diego CA 92121. He recently has only one registered license in Allopathic & Osteopathic Physicians / Plastic Surgery, which is considered as his primary health care specialty. Broder, Kevin Wayne can be contacted via phone (858) 453-7224.Contact Information
Primary practice address
4510 Executive Drive Suite 200
San Diego CA 92121
Phone: (858) 453-7224
Fax: (858) 453-7268
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Allopathic & Osteopathic Physicians / Plastic Surgery | 208200000X | A82409 | California |
Profile Details
NPI number | 1205885902 |
---|---|
LBN Legal business name | Broder, Kevin Wayne |
Credentials | Doctor of Medicine (MD) |
Entity | Individual |
Sole proprietor 1 | Yes |
Enumeration date | May 9th, 2006 |
Last updated | Sep 5th, 2012 - about 13 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.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1205885902 | NPPES |
California | MEDICAID | 00A824090 |
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