MEDICARE: DR. GEORGE HECTOR BROUILLET JR. 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	207X00000X	Orthopaedic Surgery Physician	D19096	MD

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	:	1942202130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE HECTOR BROUILLET JR. M.D.

Provider Business Mailing Address
First Line	:	3421 BENSON AVE
Second Line	:	STE 100
City	:	BALTIMORE
State	:	MD
Zip	:	21227-1011
Country	:	US
Telephone Number	:	410-644-1880
Fax Number	:	410-646-3623

Provider Business Practice Location Address
First Line	:	3421 BENSON AVE
Second Line	:	STE 100
City	:	BALTIMORE
State	:	MD
Zip	:	21227-1011
Country	:	US
Telephone Number	:	410-644-1880
Fax Number	:	410-646-3623

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	03/07/2011

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Directions to “ DR. GEORGE HECTOR BROUILLET JR. M.D.” Practice Location

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