Individual
DR. TED BROCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3200 CANYON LAKE DR, RAPID CITY, SD 57702-8114
(605) 355-2500
Mailing address
14420 SILVER MOUNTAIN ROAD, RAPID CITY, SD 57702
(605) 343-0431
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
030436
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00406766M
—
GA
05
—
790611N
—
NC
Enumeration date
05/03/2006
Last updated
07/09/2007
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