MEDICARE: ROBERT THORBROGGER 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	2085R0202X	Diagnostic Radiology Physician	20199	IA

Other Identifiers

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

General Provider Information

NPI Number	:	1386647881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT THORBROGGER MD

Provider Business Mailing Address
First Line	:	24376 140TH ST
Second Line	:
City	:	SPIRIT LAKE
State	:	IA
Zip	:	51360-7043
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	24376 140TH ST
Second Line	:
City	:	SPIRIT LAKE
State	:	IA
Zip	:	51360-7043
Country	:	US
Telephone Number	:	712-886-0997
Fax Number	:

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	05/30/2012

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