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General NPI Number Information
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NPI Number | 1073689683
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Entity Type | Individual
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Provider Name | JERALYN ELLICE BROSSFIELD MD
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Gender | Female
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Dates
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Enumeration Date | 11/27/2006
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Last Update Date | 10/19/2020
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Provider Practice Location Address
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Address Line | 72301 COUNTRY CLUB DR STE 104
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City | RANCHO MIRAGE
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State | CA
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Zip | 92270-8007
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Country | US
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Telephone | 760-573-2761
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Fax | 760-797-7189
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Provider Business Mailing Address
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Address Line | 8 WATERLOO CT
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City | RANCHO MIRAGE
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State | CA
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Zip | 92270-1663
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Country | US
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Telephone | 760-567-8208
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Fax | 760-797-7189
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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 | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | A064527
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License Number State | CA
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