Provider Demographics
NPI:1962776526
Name:ROBERT A. BRODNER, MD, PA
Entity type:Organization
Organization Name:ROBERT A. BRODNER, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-833-4054
Mailing Address - Street 1:1411 N. FLAGLER DR.
Mailing Address - Street 2:SUITE 5900
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-3412
Mailing Address - Country:US
Mailing Address - Phone:561-833-6388
Mailing Address - Fax:561-833-6353
Practice Address - Street 1:1411 N. FLAGLER DR.
Practice Address - Street 2:SUITE 5900
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-3412
Practice Address - Country:US
Practice Address - Phone:561-833-6388
Practice Address - Fax:561-833-6353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0046672207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL61463OtherPROVIDER NUMBER
FL04251300Medicaid
FL9046344988Medicare PIN
FL61463OtherPROVIDER NUMBER