Individual
JOHN M BROCKENBROUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12303 NE 130TH LN STE 400, KIRKLAND, WA 98034-3041
(425) 899-4590
(425) 899-4591
Mailing address
PO BOX 34036, SEATTLE, WA 98124-1036
(425) 899-3292
(425) 899-3269
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
036101927
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6447860011
—
IL
Enumeration date
07/11/2006
Last updated
12/12/2017
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