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General NPI Number Information
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NPI Number | 1033778758
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Entity Type | Individual
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Provider Name | MICHAEL FRANCIS BRODERICK DO
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Gender | Male
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Dates
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Enumeration Date | 06/06/2019
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Last Update Date | 08/29/2024
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Provider Practice Location Address
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Address Line | 2901 4TH ST
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City | LONGVIEW
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State | TX
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Zip | 75605-5128
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Country | US
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Telephone | 903-758-1818
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Fax |
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Provider Business Mailing Address
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Address Line | 707 HOLLYBROOK DR
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City | LONGVIEW
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State | TX
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Zip | 75605-2410
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | V2612
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | V2612
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License Number State | TX
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