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NPI Code Detail

MEDICARE: RONALD L BROCKETT CRNA

MEDICARE: RONALD L BROCKETT CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse Anesthetist28779WV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1104996438
Entity Type Code : Individual
Provider Name (Legal Business Name) : RONALD L BROCKETT CRNA
Provider Business Mailing Address
First Line : 549 CENTER AVE
Second Line :
City : ROMNEY
State : WV
Zip : 26757-1352
Country : US
Telephone Number : 304-822-4651
Fax Number : 304-822-7809
Provider Business Practice Location Address
First Line : 549 CENTER AVE
Second Line :
City : ROMNEY
State : WV
Zip : 26757-1352
Country : US
Telephone Number : 304-822-4651
Fax Number : 304-822-7809
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/08/2006
Last Update Date : 07/08/2007

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Directions to “ RONALD L BROCKETT CRNA” Practice Location

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