Provider Demographics
NPI:1427090547
Name:BROSBE, ROBERT JON (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JON
Last Name:BROSBE
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 1:169 MARTIN AVE
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-1724
Mailing Address - Country:US
Mailing Address - Phone:717-738-6414
Mailing Address - Fax:717-738-6690
Practice Address - Street 1:169 MARTIN AVE
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-1724
Practice Address - Country:US
Practice Address - Phone:717-738-6414
Practice Address - Fax:717-738-6690
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD024138E2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011230790004Medicaid
PA0011230790004Medicaid
PA444226D2UMedicare PIN