Active NPI
Douglas C Brockmann, M.D.
- Anesthesiology Physician
- Redlands, CA
National Provider Identifier
1275560914
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- G41371
- Practice address
- 2 W Fern Ave
Redlands, CA 92373-5916 - Phone
- (909) 793-3311
- Fax
- (909) 796-4158
- NPI assigned
- Jun 27, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | G41371 | CA | Primary |
Addresses
Primary practice location
2 W Fern Ave
Redlands, CA 92373-5916
Mailing address
PO Box 12209
San Bernardino, CA 92423-2209
Phone (909) 335-4188
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G413710 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G41371 | CA | MD | Anesthesiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151366400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1582675200000",
"number": "1275560914",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 12209",
"city": "SAN BERNARDINO",
"state": "CA",
"postal_code": "924232209",
"telephone_number": "909-335-4188"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2 W FERN AVE",
"city": "REDLANDS",
"state": "CA",
"postal_code": "923735916",
"telephone_number": "909-793-3311",
"fax_number": "909-796-4158"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROCKMANN",
"first_name": "DOUGLAS",
"middle_name": "C",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-27",
"last_updated": "2020-02-26",
"certification_date": "2020-02-26",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "CA",
"license": "G41371",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00G413710",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Redlands, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.