Healthcare Provider Details

I. General information

NPI: 1619544293
Provider Name (Legal Business Name): JAMES BROADBENT DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5380 S RAINBOW BLVD STE 236
LAS VEGAS NV
89118-1879
US

IV. Provider business mailing address

5380 S RAINBOW BLVD STE 236
LAS VEGAS NV
89118-1879
US

V. Phone/Fax

Practice location:
  • Phone: 702-778-2204
  • Fax:
Mailing address:
  • Phone: 702-778-2204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number20259
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberDO3850
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: