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NPI Code Detail

MEDICARE: DR. JOHN R. BROSHEARS MD

MEDICARE: DR. JOHN R. BROSHEARS 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
1207ZP0102XAnatomic Pathology & Clinical Pathology Physician01029754AIN
2207ZP0102XAnatomic Pathology & Clinical Pathology PhysicianME0037595FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2000000092720OTHERINANTHEM
3000000009158OTHERINMPLAN

General Provider Information

NPI Number : 1295711018
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN R. BROSHEARS MD
Provider Business Mailing Address
First Line : P.O. BOX 15079
Second Line : BRADENTON PATHOLOGY, P.A.
City : BRADENTON
State : FL
Zip : 34280
Country : US
Telephone Number : 941-798-6177
Fax Number : 941-798-6168
Provider Business Practice Location Address
First Line : 2020 59TH ST W
Second Line :
City : BRADENTON
State : FL
Zip : 34209-4604
Country : US
Telephone Number : 941-798-6177
Fax Number : 941-798-6168
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/22/2005
Last Update Date : 05/02/2011

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