Individual
RUSSELL C BROCKWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2950 CLEVELAND CLINIC BLVD, WESTON, FL 33331-3625
(954) 659-5000
Mailing address
113 NE 21ST ST, WILTON MANORS, FL 33305-1045
(239) 776-6096
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
ME98102
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000007602
BLUE CROSS
AL
01
—
000007604
BLUE CROSS
AL
01
—
000007609
BLUE CROSS
AL
05
—
000007609
—
AL
05
—
009916165
—
AL
05
—
009916175
—
AL
01
—
010033CG86101
SECTION 1011
AL
01
—
050065291
RAILROAD MEDICARE
AL
01
—
06857292
MISSISSIPPI MEDICAID
MS
01
—
42512
HEALTHSPRING
AL
01
—
G86101
VIVA
AL
Enumeration date
06/07/2006
Last updated
12/21/2023
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