Individual
DR. JENNIFER ELAINE BROCKMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
321 W PROMENADE ST, MEXICO, MO 65265-2719
(573) 582-1234
(573) 582-1212
Mailing address
PO BOX 8525, SAINT LOUIS, MO 63126-0525
(314) 843-7500
(314) 843-7503
Taxonomy
Speciality
Code
Description
License number
State
2084F0202X
Forensic Psychiatry Physician
Primary
2004003502
MO
2084F0202X
Forensic Psychiatry Physician
A96005
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2004003502
MISSOURI STATE LICENSE
MO
01
—
A96005
STATE LICENSE
CA
Enumeration date
10/20/2006
Last updated
03/07/2023
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