Individual
MARK JAMES BROXTERMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8107 CIMARRON MEADOWS WAY, LAS VEGAS, NV 89147-5055
(702) 429-2654
(702) 221-4275
Mailing address
8107 CIMARRON MEADOWS WAY, LAS VEGAS, NV 89147-5055
(702) 429-2654
(702) 221-4275
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9005051113
—
NV
Enumeration date
05/23/2011
Last updated
06/07/2011
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