Individual
DR. KIRK EDWARD BROCKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1001 CARDWELL ST, ST. CLAIR, MO 63077
(636) 629-3300
(636) 629-7377
Mailing address
1001 CARDWELL STREET, ST. CLAIR, MO 63077
(636) 629-3300
(636) 629-7377
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
R2F53
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
202458204
—
MO
01
—
P01134547
RAILROAD MEDICARE
MO
Enumeration date
07/30/2005
Last updated
03/11/2015
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