Individual
JACOB BROCKMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
18700 N 64TH DR STE 205, GLENDALE, AZ 85308-7112
(602) 277-6211
Mailing address
1423 N POMEROY, MESA, AZ 85201-2714
(707) 978-9002
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
9130
AZ
Other
Enumeration date
06/09/2022
Last updated
06/09/2022
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