Individual
ANDREW JOHN VAN BROCKLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
8333 N DAVIS HWY, PENSACOLA, FL 32514-6050
(850) 474-8015
(850) 969-2840
Mailing address
8333 N DAVIS HWY, PENSACOLA, FL 32514-6050
(850) 474-8100
(850) 474-8083
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
OS015794
PA
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
OS11531
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009795100
—
FL
Enumeration date
10/14/2011
Last updated
04/16/2015
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