MEDICARE: BERNETTA E BROUGHTON M.D.

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	208000000X	Pediatrics Physician	15087	AZ
2	2080A0000X	Pediatric Adolescent Medicine Physician	15087	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AZ0182590	OTHER	AZ	BCBS
2	1Z8746	OTHER	AZ	HEALTHNET
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	770934	OTHER	AZ	UNITED HEALTHCARE
5	85031A006	OTHER	AZ	TRICARE

General Provider Information

NPI Number	:	1235134859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BERNETTA E BROUGHTON M.D.

Provider Business Mailing Address
First Line	:	4700 N 51ST AVE
Second Line	:	STE 4
City	:	PHOENIX
State	:	AZ
Zip	:	85031-1237
Country	:	US
Telephone Number	:	623-846-7575
Fax Number	:	623-247-6386

Provider Business Practice Location Address
First Line	:	4700 N 51ST AVE
Second Line	:	STE 4
City	:	PHOENIX
State	:	AZ
Zip	:	85031-1237
Country	:	US
Telephone Number	:	623-846-7575
Fax Number	:	623-247-6386

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

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	09/11/2025

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Directions to “ BERNETTA E BROUGHTON M.D.” Practice Location

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