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Individual
THOMAS A. BROUGHAN
Active
Individual
THOMAS A. BROUGHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101247418
VA
208600000X
Surgery Physician
35065
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100041140B
—
OK
05
—
350658
—
SC
01
—
AA96791955
MEDICARE PTAN
SC
Enumeration date
01/26/2006
Last updated
06/16/2015
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