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General NPI Number Information
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NPI Number | 1063618858
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Entity Type | Individual
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Provider Name | CHAD BROCKARDT M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/27/2007
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Last Update Date | 12/06/2025
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Provider Practice Location Address
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Address Line | 2 W FERN AVE
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City | REDLANDS
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State | CA
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Zip | 92373-5916
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Country | US
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Telephone | 909-335-4102
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 35380
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City | LAS VEGAS
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State | NV
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Zip | 89133-5380
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Country | US
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Telephone | 702-579-3203
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | A105664
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License Number State | CA
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