MEDICARE: JOHN J BROTHWELL 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	208600000X	Surgery Physician	17361	AZ

General Provider Information

NPI Number	:	1225037310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN J BROTHWELL MD

Provider Business Mailing Address
First Line	:	9856 W VILLA LINDO DR
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85383-1339
Country	:	US
Telephone Number	:	623-979-4341
Fax Number	:

Provider Business Practice Location Address
First Line	:	9856 W VILLA LINDO DR
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85383-1339
Country	:	US
Telephone Number	:	623-979-4341
Fax Number	:

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

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	05/01/2015

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