Individual
CAROL LYNN BROKSCHMIDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
CORNER OF RT. N12 AND N7, FORT DEFIANCE PHS HOSPITAL, FORT DEFIANCE, AZ 86504
(928) 729-8757
Mailing address
9522 E MINTON ST, MESA, AZ 85207-2538
(480) 354-8766
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
19747
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19747
LICENSE
AZ
05
—
52424553
—
NM
01
—
893356
AHCCCS
AZ
Enumeration date
10/31/2006
Last updated
07/08/2007
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