Individual
DR. BRADLEY R BROBECK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1000 MAR WALT DR, FORT WALTON BEACH, FL 32547-6708
(850) 315-7807
(850) 863-7579
Mailing address
1000 MAR WALT DR, FORT WALTON BEACH, FL 32547-6708
(850) 315-7807
(850) 863-7579
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
00027338
AL
2085R0202X
Diagnostic Radiology Physician
220353
MA
2085R0202X
Diagnostic Radiology Physician
Primary
ME95580
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009939598
—
AL
05
—
106712
—
AL
05
—
106713
—
AL
05
—
108076
—
AL
05
—
108488
—
AL
05
—
2060671
—
MA
05
—
275424000
—
FL
01
—
469114
TUFTS HEALTH PLAN
MA
01
—
J27261
BCBS MA
MA
Enumeration date
12/27/2005
Last updated
11/12/2014
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