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General NPI Number Information
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NPI Number | 1396796553
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Entity Type | Organization
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Legal Business Name | BROOKRIDGE INTERNAL MEDICINE ASSOCIATES, PA
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Dates
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Enumeration Date | 05/13/2006
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Last Update Date | 01/13/2020
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Provider Practice Location Address
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Address Line | 300 N 3RD ST STE A
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City | LONGVIEW
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State | TX
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Zip | 75601
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Country | US
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Telephone | 903-315-2907
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Fax | 903-315-2927
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Provider Business Mailing Address
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Address Line | 300 N 3RD ST
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City | LONGVIEW
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State | TX
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Zip | 75601-6505
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Country | US
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Telephone | 903-315-2907
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Fax | 903-315-2927
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Authorized Official
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Title or Position | OWNER
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Name | BRENDA M VOZZA
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Credential | MD
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Telephone | 903-315-2907
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | K6399
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License Number State | TX
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