Provider Demographics
NPI:1124262506
Name:BROXHAM, ERIC JEFFREY (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:JEFFREY
Last Name:BROXHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 29019
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91209-9019
Mailing Address - Country:US
Mailing Address - Phone:805-370-4697
Mailing Address - Fax:
Practice Address - Street 1:351 ROLLING OAKS DR
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-1275
Practice Address - Country:US
Practice Address - Phone:805-373-8582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-29
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA111301207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology