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General NPI Number Information
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NPI Number | 1972114908
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Entity Type | Organization
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Legal Business Name | ELLIOTT BRODBAKER, MD, PLLC
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Dates
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Enumeration Date | 08/13/2020
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Last Update Date | 11/08/2025
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Provider Practice Location Address
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Address Line | 1651 N COLLINS BLVD STE 245
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City | RICHARDSON
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State | TX
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Zip | 75080-3787
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Country | US
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Telephone | 972-889-3937
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Fax |
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Provider Business Mailing Address
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Address Line | 1651 N COLLINS BLVD STE 245
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City | RICHARDSON
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State | TX
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Zip | 75080-3787
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Country | US
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Telephone | 469-998-3554
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Fax |
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Authorized Official
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Title or Position | OPHTHALMOLOGIST
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Name | DR. ELLIOTT BRODBAKER
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Credential | MD
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Telephone | 469-998-3554
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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