Individual
MR. WILLIAM GEORGE BROADHURST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
60 OLD NEW MILFORD RD, SUITE 3E, BROOKFIELD, CT 06804-2430
(203) 775-6205
(203) 775-2414
Mailing address
60 OLD NEW MILFORD RD, SUITE 3E, BROOKFIELD, CT 06804-2430
(203) 775-6205
(203) 775-2414
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
001092
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
109200
CONNECTICARE
CT
01
—
290001092CT05
BLUE CROSS BLUE SHIELD
CT
01
—
2V5849
HEALTHNET
CT
01
—
P2679140
OXFORD
CT
Enumeration date
10/04/2005
Last updated
10/28/2010
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