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General NPI Number Information
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NPI Number | 1346703832
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Entity Type | Individual
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Provider Name | WILLIAM JORDAN BROCKWAY MD
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Gender | Male
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Dates
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Enumeration Date | 04/11/2019
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Last Update Date | 06/06/2025
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Provider Practice Location Address
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Address Line | 3333 S PINNACLE HILLS PKWY STE 300A
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City | ROGERS
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State | AR
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Zip | 72758-9000
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Country | US
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Telephone | 479-271-7077
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Fax | 479-271-7035
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Provider Business Mailing Address
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Address Line | PO BOX 776084
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City | CHICAGO
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State | IL
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Zip | 60677-6084
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Country | US
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Telephone | 479-271-7077
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Fax | 479-271-7035
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | U6691
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 2025004031
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | E-18732
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License Number State | AR
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