Individual
DR. MARK BRODEUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3625 UNIVERSITY BLVD S, EMERGENCY DEPT, JACKSONVILLE, FL 32216-4207
(904) 346-3606
(904) 346-0113
Mailing address
PO BOX 860554, ORLANDO, FL 32886-0554
(904) 346-3606
(904) 346-0113
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
ME0090285
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
269864100
FLORIDA MEDICAID
FL
05
—
269864100
—
FL
01
—
44098
BCBS
FL
05
—
787365756A
—
GA
01
—
P00139639
RRMCR
FL
01
—
P00139639
RAILROAD MEDICARE
—
Enumeration date
01/04/2006
Last updated
07/30/2008
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