MEDICARE: BRIAN P BROCKER 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	207T00000X	Neurological Surgery Physician	35-066899	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000138342	OTHER	OH	ANTHEM
2	0600127	OTHER	OH	UNITED HEALTHCARE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	4597438	OTHER	OH	AETNA
5	7405468	OTHER	OH	CIGNA
6	000000106032	OTHER	OH	UNISON

General Provider Information

NPI Number	:	1578548830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN P BROCKER M.D.

Provider Business Mailing Address
First Line	:	1616 COVINGTON ST
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44510-1244
Country	:	US
Telephone Number	:	330-747-9215
Fax Number	:	330-747-9248

Provider Business Practice Location Address
First Line	:	1616 COVINGTON ST
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44510-1244
Country	:	US
Telephone Number	:	330-747-9215
Fax Number	:	330-747-9248

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

Provider Enumeration Date	:	12/09/2005
Last Update Date	:	09/11/2014

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