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1134124183

NPI Code Detail

MEDICARE: DAVID M BROUHARD MD

MEDICARE: DAVID M BROUHARD MD

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
1	207L00000X	Anesthesiology Physician	35.130310	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2026475E	OTHER	NC	MEDICARE PTAN
3	2026475C	OTHER	NC	MEDICARE PTAN

Other Identifiers

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

General Provider Information

NPI Number	:	1134124183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID M BROUHARD MD

Provider Business Mailing Address
First Line	:	PO BOX 932759
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44193-0015
Country	:	US
Telephone Number	:	937-293-8228
Fax Number	:	937-293-8229

Provider Business Practice Location Address
First Line	:	3535 SOUTHERN BLVD
Second Line	:
City	:	KETTERING
State	:	OH
Zip	:	45429-1221
Country	:	US
Telephone Number	:	937-293-8228
Fax Number	:	937-293-8229

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	08/31/2020

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Directions to “ DAVID M BROUHARD MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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