Andrew Martin Broselow, MD

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

30150 Issued in OK

Practice address

1800 S Douglas Blvd
Renaissance OB/GYN
Midwest City, OK 73130-6224

Phone

(405) 733-4985

NPI assigned

Apr 11, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Covenant Medical Group

  • Family Medicine Physician
  • Lubbock, TX
  • NPI 1376598904

  Obstetrics & Gynecology

  NPD (past)

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

{
    "created_epoch": "1144713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1379376000000",
    "number": "1619930328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 S DOUGLAS BLVD",
            "address_2": "RENAISSANCE OB/GYN",
            "city": "MIDWEST CITY",
            "state": "OK",
            "postal_code": "731306224",
            "telephone_number": "405-733-4985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 S DOUGLAS BLVD",
            "address_2": "RENAISSANCE OB/GYN",
            "city": "MIDWEST CITY",
            "state": "OK",
            "postal_code": "731306224",
            "telephone_number": "405-733-4985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROSELOW",
        "first_name": "ANDREW",
        "middle_name": "MARTIN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-11",
        "last_updated": "2013-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "TX",
            "license": "K3559",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "OK",
            "license": "30150",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "045318505",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• William Broiles
• Kayla Bronson, RBT
• Brookdale Senior Living Communities, Inc.
• Adrianna Nicole Brooks, MS, CF-SLP
• Tashika Brooks
• Ashley Brown
• Aviance Brown
• Cissie Brown
• Devon Brown
• Evans Brown Jr.

• Obstetrics & Gynecology Physician in Midwest City, OK
• Providers in Midwest City, OK by specialty
• Obstetrics & Gynecology Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2013; 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.