Individual
JEFF E BROCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ED.D
Contact information
Practice address
650 MEMORIAL DR BLDG 68, POCATELLO, ID 83209-0001
(208) 282-2556
Mailing address
650 MEMORIAL DRIVE, BOX 8116, POCATELLO, ID 83209
(208) 282-2556
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
AUD1233
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004413800
—
ID
01
—
AU787
BLUE CROSS GROUP # AU753
ID
Enumeration date
07/27/2006
Last updated
04/01/2013
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