Individual
BERNETTA E BROUGHTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4700 N 51ST AVE, STE 4, PHOENIX, AZ 85031-1237
(623) 846-7575
(623) 247-6386
Mailing address
4700 N 51ST AVE, STE 4, PHOENIX, AZ 85031-1237
(623) 846-7575
(623) 247-6386
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
15087
AZ
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
15087
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1Z8746
HEALTHNET
AZ
05
—
251794
—
AZ
01
—
770934
UNITED HEALTHCARE
AZ
01
—
85031A006
TRICARE
AZ
01
—
AZ0182590
BCBS
AZ
Enumeration date
06/20/2005
Last updated
09/11/2025
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