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Individual
DR. KENT GREGORY BROCKMANN
Active
Individual
DR. KENT GREGORY BROCKMANN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
44519
MN
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
44519
MN
261QM0850X
Adult Mental Health Clinic/Center
48376-20
WI
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
087897900
—
MN
01
—
15-45530
MEDICA/UBH ID
MN
01
—
273L3BR
BLUECROSS/BLUESHIELD MN
MN
Enumeration date
05/16/2006
Last updated
06/25/2013
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