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General NPI Number Information
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NPI Number | 1205032463
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Entity Type | Organization
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Legal Business Name | WEST BROOKFIELD FAMILY PRACTICE
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Dates
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Enumeration Date | 06/25/2007
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Last Update Date | 06/17/2008
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Provider Practice Location Address
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Address Line | 46 NORTH MAIN ST
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City | WEST BROOKFIELD
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State | MA
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Zip | 01585
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Country | US
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Telephone | 508-867-8977
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Fax | 508-867-7361
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Provider Business Mailing Address
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Address Line | 46 NORTH MAIN STREET
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City | WEST BROOKFIELD
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State | MA
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Zip | 01585-1044
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Country | US
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Telephone | 508-867-8977
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Fax | 508-867-7361
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. GWEN MARIE BROZ
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Credential | D.O.
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Telephone | 508-867-8977
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 73319
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License Number State | MA
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