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General NPI Number Information
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NPI Number | 1861656654
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Entity Type | Organization
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Legal Business Name | DR. EDWARD BROMBERG
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Dates
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Enumeration Date | 07/11/2008
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Last Update Date | 07/17/2008
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Provider Practice Location Address
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Address Line | 1413 THOMPSON CIR SUITE A
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City | GARDENDALE
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State | AL
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Zip | 35071-2953
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Country | US
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Telephone | 205-631-8887
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Fax | 205-631-9126
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Provider Business Mailing Address
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Address Line | 1413 THOMPSON CIR SUITE A
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City | GARDENDALE
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State | AL
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Zip | 35071-2953
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Country | US
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Telephone | 205-631-8887
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Fax | 205-631-9126
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Authorized Official
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Title or Position | ORTHOPEDIC SURGEON
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Name | DR. EDWARD BROMBERG
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Credential | M.D.
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Telephone | 205-631-8887
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 6794
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License Number State | AL
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