Individual
DR. TARA L BROADWATER
Active
Individual
DR. TARA L BROADWATER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
40655
MN
2084P0800X
Psychiatry Physician
Primary
40655
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0573816
MEDICAID
IA
01
—
124673
UCARE
MN
01
—
1965380
AMERICAS PPO
MN
01
—
388R8BU
BCBS
MN
01
—
41084933956001C212
CHAMPUS
—
05
—
526011600
—
MN
01
—
HP36174
HEALTH PARTNERS
MN
01
—
NA2951032151
PREFFERED ONE
MN
01
—
P00138242
RR MEDICARE
—
Enumeration date
01/10/2006
Last updated
04/26/2023
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