Larson, Brough, and Brockman PSC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

LARSON, BROUGH, AND BROCKMAN PSC

Practice address

5109 New Cut Rd
Louisville, KY 40214-2745

Phone

(502) 361-1197

Fax

(502) 361-0090

NPI assigned

May 10, 2006

Organization subpart

No

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

Authorized official

Name

Dana L Evans

Title

Provider Enrollment Specialist

Phone

(270) 744-9600

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1147219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1313971200000",
    "number": "1871543025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9150",
            "city": "PADUCAH",
            "state": "KY",
            "postal_code": "420029150",
            "telephone_number": "270-744-9600",
            "fax_number": "270-744-8642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5109 NEW CUT RD",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402142745",
            "telephone_number": "502-361-1197",
            "fax_number": "502-361-0090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LARSON, BROUGH, AND BROCKMAN PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-10",
        "last_updated": "2011-08-22",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "DANA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PROVIDER ENROLLMENT SPECIALIST",
        "authorized_official_telephone_number": "270-744-9600"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100106000",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Renato V Larocca, M.D.
• Kayla N Larosa, PSYCHOLOGIST
• Larry M. Raskin, PH.D., P.S.C.
• Andrew James Larson, MD
• Ashley Dru Larson
• Ellen Larson
• Gerald M Larson, MD
• John B Larson, MD
• Kelly Larson, BSW
• Nancy S. Larson, M.ED. CCC-SLP

• Pediatrics Physician in Louisville, KY
• Providers in Louisville, KY by specialty
• Pediatrics Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2011; 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.