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NPI Code Detail

MEDICARE: DR. KIMBERLY BROWN BROCKENBROUGH M.D.

MEDICARE: DR. KIMBERLY BROWN BROCKENBROUGH M.D.
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
12085R0202XDiagnostic Radiology Physician77183AZ
22085R0202XDiagnostic Radiology PhysicianMD60484894WA
32085U0001XDiagnostic Ultrasound Physician036107196IL
42085R0202XDiagnostic Radiology Physician01093712AIN

General Provider Information

NPI Number : 1205864204
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KIMBERLY BROWN BROCKENBROUGH M.D.
Provider Business Mailing Address
First Line : 2929 E THOMAS RD
Second Line :
City : PHOENIX
State : AZ
Zip : 85016-8034
Country : US
Telephone Number : 602-470-5000
Fax Number : 602-470-5064
Provider Business Practice Location Address
First Line : 2601 E ROOSEVELT ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85008-4973
Country : US
Telephone Number : 602-344-5011
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/29/2006
Last Update Date : 05/18/2026

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