MEDICARE: DR. ANNE LINDSEY BRODERICK D.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	1223P0300X	Periodontics	DN 19411	FL

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	:	1831419456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANNE LINDSEY BRODERICK D.M.D

Provider Business Mailing Address
First Line	:	15660 SW 12TH ST
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33027-2233
Country	:	US
Telephone Number	:	954-558-4635
Fax Number	:

Provider Business Practice Location Address
First Line	:	7011 CYPRESS TER
Second Line	:	SUITE 101
City	:	FORT MYERS
State	:	FL
Zip	:	33907-8800
Country	:	US
Telephone Number	:	954-558-4635
Fax Number	:

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

Provider Enumeration Date	:	06/04/2010
Last Update Date	:	07/05/2014

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