Individual
DR. JOHN JOSEPH BRODERICK-CANTWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7101 US HIGHWAY 90 STE 103, DAPHNE, AL 36526-9510
(251) 517-5800
(256) 429-9411
Mailing address
600 SUN TEMPLE DR, MADISON, AL 35758-8643
(256) 975-4291
(256) 288-3334
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
28950
AL
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
28950
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1353044
—
CO
01
—
28903
MEDICAL LICENSE
SC
01
—
28950
MEDICAL LICENSE
AL
01
—
DR-35304
MEDICAL LICENSE
CO
05
—
Q48343
—
SC
Enumeration date
08/10/2006
Last updated
02/05/2024
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