Walter G Broadnax, M.D.

Primary specialty

Pain Medicine (Psychiatry & Neurology) PhysicianTaxonomy code 2084P2900X

License

35060685 Issued in OH

Practice address

5505 Fair LN
Cincinnati, OH 45227-3401

Phone

(513) 421-7246

Fax

(513) 421-7796

NPI assigned

Mar 14, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1003940032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1220 PADDOCK HILLS AVE",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452291218",
            "telephone_number": "513-421-7246",
            "fax_number": "513-421-7796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5505 FAIR LN",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452273401",
            "telephone_number": "513-421-7246",
            "fax_number": "513-421-7796"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROADNAX",
        "first_name": "WALTER",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-14",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P2900X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Pain Medicine",
            "state": "OH",
            "license": "35060685",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0860917",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Samuel Britton
• Kyle Brizendine, MD
• Savannah Brizendine
• Charles Edward Broadnax Jr.
• Christina Broadnax
• Arthur Thomas Broadstock, MD
• Kassius James Broadus
• Augustus Brock, D.D.S.
• Christina Brock, LISW-S
• Jasmine Brock

• Pain Medicine (Psychiatry & Neurology) Physician in Cincinnati, OH
• Providers in Cincinnati, OH by specialty
• Pain Medicine (Psychiatry & Neurology) Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.