MEDICARE: RICHARD J BROUETTE 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	207Q00000X	Family Medicine Physician	G069457	CA

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	:	1942299342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD J BROUETTE MD

Provider Business Mailing Address
First Line	:	426 PARKVIEW AVE STE 1400
Second Line	:
City	:	YUBA CITY
State	:	CA
Zip	:	95993-5232
Country	:	US
Telephone Number	:	306-829-6405
Fax Number	:	530-751-9826

Provider Business Practice Location Address
First Line	:	426 PARKVIEW AVE
Second Line	:
City	:	YUBA CITY
State	:	CA
Zip	:	95993-5232
Country	:	US
Telephone Number	:	530-682-9640
Fax Number	:	530-751-9826

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

Provider Enumeration Date	:	10/18/2005
Last Update Date	:	11/08/2018

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