=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043639164
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DARREN BROCKIE M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/16/2014
-----------------------------------------------------
Last Update Date | 11/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6 13TH AVE E
-----------------------------------------------------
City | POLSON
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59860-5315
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-883-5680
-----------------------------------------------------
Fax | 406-883-8910
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 31001
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91110-4110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-883-5680
-----------------------------------------------------
Fax | 406-883-8910
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | MED-PHYS-LIC-58267
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------