Healthcare Provider Details

I. General information

NPI: 1346213394
Provider Name (Legal Business Name): STEPHEN KEITH BROCKWAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2340 CLAY ST FL 7 CALIFORNIA PACIFIC MEDICAL CENTER
SAN FRANCISCO CA
94115-1932
US

IV. Provider business mailing address

2340 CLAY ST FL 7 CALIFORNIA PACIFIC MEDICAL CENTER
SAN FRANCISCO CA
94115-1932
US

V. Phone/Fax

Practice location:
  • Phone: 415-600-5739
  • Fax:
Mailing address:
  • Phone: 415-600-5739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA81223
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA81223
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: