Individual
BRYAN KENT BROADBENT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
2300 E 30TH ST BLDG D-101, FARMINGTON, NM 87401-8991
(505) 327-1400
(505) 564-3202
Mailing address
2300 E 30TH ST BLDG D-101, FARMINGTON, NM 87401-8991
(505) 327-1400
(505) 564-3202
Taxonomy
Speciality
Code
Description
License number
State
213ES0131X
Foot Surgery Podiatrist
DP 00375
OR
213ES0131X
Foot Surgery Podiatrist
POD.0000831
CO
213ES0131X
Foot Surgery Podiatrist
Primary
POD417
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10432353
—
NM
Enumeration date
10/25/2006
Last updated
10/01/2019
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