Individual
ALAN CLAYTON BROCKHURST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
720 W OAK ST, STE. 101, KISSIMMEE, FL 34741-4989
(407) 846-3166
Mailing address
720 W OAK ST, STE. 101, KISSIMMEE, FL 34741-4989
(407) 846-3166
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
ME115271
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4881673-10
—
MI
01
—
C86007
BCBSM GROUP
MI
01
—
P00374266
RR MEDICARE
MI
Enumeration date
05/12/2006
Last updated
04/18/2013
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