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General NPI Number Information
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NPI Number | 1962691766
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Entity Type | Individual
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Provider Name | ROBERT JOEL BROSELOW MD
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Gender | Male
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Dates
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Enumeration Date | 10/17/2007
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Last Update Date | 10/17/2007
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Provider Practice Location Address
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Address Line | 4009 19TH ST SUITE E
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City | LUBBOCK
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State | TX
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Zip | 79410-1003
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Country | US
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Telephone | 806-795-9020
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Fax | 806-795-4726
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Provider Business Mailing Address
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Address Line | 4009 19TH ST SUITE E
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City | LUBBOCK
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State | TX
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Zip | 79410-1003
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Country | US
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Telephone | 806-795-9020
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Fax | 806-795-4726
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | D9089
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License Number State | TX
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