Organization
COUNTRY DOCTOR PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SEAN D BRODALE DO (PRESIDENT)
(641) 664-1799
Entity
Organization
Contact information
Practice address
18754 US HIGHWAY 63, BLOOMFIELD, IA 52537-6803
(641) 664-1799
(641) 664-1663
Mailing address
18754 US HIGHWAY 63, BLOOMFIELD, IA 52537-6803
(641) 664-1799
(641) 664-1663
Taxonomy
Speciality
Code
Description
License number
State
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
3485
IA
207Q00000X
Family Medicine Physician
Primary
3485
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
209029206
—
MO
05
—
2424325
—
IA
Enumeration date
07/04/2006
Last updated
05/21/2008
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