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1134124183

NPI Code Detail

MEDICARE: DAVID M BROUHARD MD

MEDICARE: DAVID M BROUHARD MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	35.130310	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2026475E	OTHER	NC	MEDICARE PTAN
3	2026475C	OTHER	NC	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134124183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID M BROUHARD MD

Provider Business Mailing Address
First Line	:	PO BOX 932759
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44193-0015
Country	:	US
Telephone Number	:	937-293-8228
Fax Number	:	937-293-8229

Provider Business Practice Location Address
First Line	:	3535 SOUTHERN BLVD
Second Line	:
City	:	KETTERING
State	:	OH
Zip	:	45429-1221
Country	:	US
Telephone Number	:	937-293-8228
Fax Number	:	937-293-8229

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	08/31/2020

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Directions to “ DAVID M BROUHARD MD” Practice Location

Language	Start Address	Practice Location

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