Broughton, Bernetta E
Broughton, Bernetta E is an sole proprietor health care provider with primary practice located at 4700 N 51St Ave Ste 4, Phoenix AZ 85031-1237. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pediatrics, Allopathic & Osteopathic Physicians / Adolescent Medicine. Allopathic & Osteopathic Physicians / Pediatrics is her primary health care specialty. Broughton, Bernetta E can be contacted via phone (623) 846-7575.Contact Information
Primary practice address
4700 N 51St Ave Ste 4
Phoenix AZ 85031-1237
Phone: (623) 846-7575
Fax: (623) 247-6386
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | 15087 | Arizona |
| Allopathic & Osteopathic Physicians / Adolescent Medicine | 2080A0000X | 15087 | Arizona |
Profile Details
| NPI number | 1235134859 |
|---|---|
| LBN Legal business name | Broughton, Bernetta E |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jun 20th, 2005 |
| Last updated | Jul 8th, 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1235134859 | NPPES |
| Arizona | Other | AZ0182590 | BCBS |
| Arizona | Other | 1Z8746 | BCBS |
| Arizona | MEDICAID | 251794 | BCBS |
| Arizona | Other | 770934 | BCBS |
| Arizona | Other | 85031A006 | BCBS |
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