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General NPI Number Information
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NPI Number | 1679877369
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Entity Type | Individual
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Provider Name | JAMES DEAN VANBROCKLIN M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/10/2011
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Last Update Date | 09/27/2016
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Provider Practice Location Address
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Address Line | 2040 E BURT RD
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City | BURT
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State | MI
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Zip | 48417-9459
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Country | US
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Telephone | 520-241-3522
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Fax |
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Provider Business Mailing Address
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Address Line | 36959 S RIBBONWOOD LN
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City | TUCSON
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State | AZ
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Zip | 85739-1210
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Country | US
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Telephone | 520-818-1925
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Fax |
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 4301024280
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License Number State | MI
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