Individual
JEFFREY N BRODER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1201 WEST AVE, NORTH AUGUSTA, SC 29841-3350
(803) 279-1030
(803) 278-1344
Mailing address
1201 WEST AVE, NORTH AUGUSTA, SC 29841-3350
(803) 279-1030
(803) 278-1344
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
15157
SC
2083X0100X
Occupational Medicine Physician
15157
SC
208D00000X
General Practice Physician
15157
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
G30017
—
SC
Enumeration date
09/09/2005
Last updated
05/27/2010
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