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General NPI Number Information
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NPI Number | 1518682988
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Entity Type | Organization
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Legal Business Name | BRODNAN MEDICAL LLC
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Dates
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Enumeration Date | 10/07/2022
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Last Update Date | 11/04/2022
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Provider Practice Location Address
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Address Line | 1531 N INDIAN RIVER DR
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City | COCOA
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State | FL
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Zip | 32922-6945
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Country | US
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Telephone | 321-544-1020
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Fax |
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Provider Business Mailing Address
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Address Line | 1531 N INDIAN RIVER DR
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City | COCOA
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State | FL
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Zip | 32922-6945
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Country | US
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Telephone | 321-544-1020
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOHN BRODNAN
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Credential |
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Telephone | 321-544-1020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number |
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License Number State |
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