Individual
MISS ROSE MAE BROUGHTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
651 ARMORY RD, DELPHI, IN 46923-1910
(765) 564-2777
(765) 564-6580
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01069257A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000898754
ANTHEM PROVIDER NUMBER
IN
05
—
201039510
—
IN
Enumeration date
06/02/2011
Last updated
12/14/2022
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