Individual
DR. PAUL EUGENE BRODERICK
Active
Individual
DR. PAUL EUGENE BRODERICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
208C00000X
Colon & Rectal Surgery Physician
Primary
02001623A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000095924
ANTHEM
IN
05
—
200037350
—
IN
01
—
MEDICARE
M400061013
IN
Enumeration date
06/30/2005
Last updated
04/14/2023
Update your record
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