Brockman, Mark A

Brockman, Mark A is an individual health care provider with primary practice located at 5109 New Cut Rd , Louisville KY 40214-2745. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as his primary health care specialty. Brockman, Mark A can be contacted via phone (502) 361-1197.

Contact Information

Primary practice address
5109 New Cut Rd Louisville KY 40214-2745
Phone: (502) 361-1197
Fax: (502) 361-0090
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 26812 Kentucky

Profile Details

NPI number 1255382628
LBN Legal business name Brockman, Mark A
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 12th, 2006
Last updated Oct 5th, 2022 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1255382628 NPPES
Kentucky MEDICAID 6426812100
Kentucky Other 000000050176

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