Healthcare Provider Details

I. General information

NPI: 1417921057
Provider Name (Legal Business Name): JAMES THOMAS BROCKMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 02/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9582 PRINCETON GLENDALE RD
HAMILTON OH
45011-9709
US

IV. Provider business mailing address

9582 PRINCETON GLENDALE RD
HAMILTON OH
45011-9709
US

V. Phone/Fax

Practice location:
  • Phone: 513-346-5640
  • Fax: 513-346-5644
Mailing address:
  • Phone: 513-346-5640
  • Fax: 513-346-5644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35055812B
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35055812
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: