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Individual

DR. JOHN E. BROOM

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
455 SAINT MICHAELS DR, SANTA FE, NM 87505-7601
(505) 820-5227
Mailing address
455 SAINT MICHAELS DR, MEDICAL STAFF OFFICE, SANTA FE, NM 87505-7601
(505) 820-5227

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
A48242
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00A482420
CA
01
1103063
UHC
05
93153775
NM
01
NM002A14
BCBS NM
NM
01
QMP000003384301
MOLINA
Enumeration date
08/04/2006
Last updated
01/21/2008
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