Healthcare Provider Details

I. General information

NPI: 1851426324
Provider Name (Legal Business Name): RICHARD JAMES BROSTROM MD MSPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COMMONWEALTH HEALTH CENTER 1 LOWER MARY HILL ROAD
SAIPAN MP
96950
US

IV. Provider business mailing address

PO BOX 10001 PMB 631
SAIPAN MP
96950
US

V. Phone/Fax

Practice location:
  • Phone: 670-234-8950
  • Fax: 670-236-8700
Mailing address:
  • Phone: 670-322-3773
  • Fax: 670-236-8700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMP-0192
License Number StateMP

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: