Healthcare Provider Details

I. General information

NPI: 1114902541
Provider Name (Legal Business Name): JOSEPH A BROMBACH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 04/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 E MEETING ST
DANDRIDGE TN
37725-5003
US

IV. Provider business mailing address

3543 MOUNTAIN VIEW LN
BANEBERRY TN
37890-4833
US

V. Phone/Fax

Practice location:
  • Phone: 865-674-0506
  • Fax:
Mailing address:
  • Phone: 865-674-0506
  • Fax: 865-397-8839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35295
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35295
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35295
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number35295
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: