Individual
DR. MARK BROCKMAN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
115 HUSTON DR STE 2, SHEPHERDSVILLE, KY 40165-7250
(502) 955-8979
(502) 955-1205
Mailing address
PO BOX 776879, CHICAGO, IL 60677-6879
(502) 272-5754
(502) 272-5339
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
51074
KY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300044581
—
IN
05
—
7100435590
—
KY
01
—
K270741
MEDICARE
KY
Enumeration date
04/03/2015
Last updated
09/20/2024
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