# JEFF E BROCKETT

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1013931450
- **Gender:** Man
- **Credential:** ED.D

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 231H00000X | Audiologist | AUD1233 | ID | Yes |

## Other

- **Enumeration date:** 07/27/2006
- **Last updated:** 04/01/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 004413800 | — | ID |
| 01 | — | AU787 | BLUE CROSS GROUP \# AU753 | ID |