Bruce Brokaw, P.A.-C.
Individual provider Active NPI Medical Physician Assistant · Wells, ME
NPI 1316159072 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1316159072
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- 0170 (NH)
- Practice address
- 400 Captain Thomas Road
Wells, ME 04090-7552 - Phone
- (603) 740-3293
- NPI assigned
- May 4, 2007
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0170 | NH | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 0170 | NH | Yes |
Addresses
Primary practice location
400 Captain Thomas Road
Wells, ME 04090-7552
Mailing address
400 Captain Thomas Rd
Wells
Maine, ME 04090
Phone (603) 740-3293
Other providers in Wells, ME
- Kayla E Billings
- Blue Swan Psychiatry, PLLC
- Lawrence Andrew Boyle
- Brian E Kaufman, DO, LLC
- Brian E. Kaufman, D.O.,LLC
- Robert P Cervenka
- Sandra Lee Cionni
- Samuel Clark
- Aaron David Cloutier
- Coastal OB GYN
All providers in Wells, ME · Medical Physician Assistant in Maine
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.