Individual
ADAM BROADWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
12222 MERIT DR STE 600, DALLAS, TX 75251-3294
(972) 715-5000
(972) 715-9976
Mailing address
PO BOX 840853, DALLAS, TX 75284-0853
(972) 233-1999
(972) 233-3666
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
AP127424
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
343470601
—
TX
01
—
8762UJ
BCBS TX
TX
01
—
P01445692
RAILROAD
TX
Enumeration date
12/12/2014
Last updated
07/19/2022
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