Healthcare Provider Details

I. General information

NPI: 1609827104
Provider Name (Legal Business Name): WILLIAM A. BROUGHTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 01/12/2021
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 UNIVERSITY HOSPITAL DRIVE MASTIN 102
MOBILE AL
36617-2300
US

IV. Provider business mailing address

PO BOX 40480
MOBILE AL
36640-0480
US

V. Phone/Fax

Practice location:
  • Phone: 251-470-5890
  • Fax: 251-471-7925
Mailing address:
  • Phone: 251-470-5890
  • Fax: 251-471-7925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number10935
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: