Kevin Wayne Broder in San Diego - Plastic Surgery
Kevin Wayne Broder - NPI 1205885902
Kevin Wayne Broder is a Plastic Surgery in San Diego, California. Kevin Wayne Broder practices all healthcare services and medical treatments related to Plastic Surgery. The NPI Number for Kevin Wayne Broder is 1205885902. The last update date is 2012-09-05.
Kevin Wayne Broder's current location address is 4510 Executive Drive, San Diego, California. You can contact this provider via phone number 8584537224 and fax number 8584537268. The mailing address for Kevin Wayne Broder is 4510 Executive Drive, San Diego, California. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Kevin Wayne Broder |
|---|---|
| Address | 4510 Executive Drive, San Diego, California |
| Phone Number | 8584537224 |
| Fax Number | 8584537268 |
| Sole Proprietor | Y |
| Credentials | MD |
NPI Number Detail
| NPI Number | 1205885902 |
|---|---|
| Provider Enumeration Date | 2006-05-09 |
| Last Updated Date | 2012-09-05 |
Provider Mailing Address Detail
| Address | 4510 Executive Drive |
|---|---|
| City | San Diego |
| State | California (CA) |
| Post Code | 92121 |
| Phone Number | 8584537224 |
| Fax Number | 8584537268 |
Provider's Primary Taxonomy Detail
| Speciality | Plastic Surgery |
|---|---|
| Taxonomy | 208200000X |
| Licence No | A82409 |
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Definition: A plastic surgeon deals with the repair, reconstruction or replacement of physical defects of form or function involving the skin, musculoskeletal system, craniomaxillofacial structures, hand, extremities, breast and trunk and external genitalia or c |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 00A824090 | CA | -- |
Post Comment/ Review Below
What is the unique 10-digit identification code issued to Kevin Wayne Broder by the Centers for Medicare & Medicaid Services?
The Kevin Wayne Broder has been assigned the NPI (National Provider Identifier) 1205885902 by the Centers for Medicare & Medicaid Services (CMS). This 10-digit code serves as a unique identifier for healthcare providers.
Where is the Kevin Wayne Broder located?
The Kevin Wayne Broder is located at 4510 Executive Drive, San Diego, CA 92121.
What is the Kevin Wayne Broder's specialty and taxonomy code?
The Kevin Wayne Broder's specialty is Plastic Surgery, and the corresponding taxonomy code is 208200000X.
When did the Kevin Wayne Broder receive its 1205885902?
The Kevin Wayne Broder was issued its 1205885902 on 2006-05-09, which is the date when the organization was assigned this unique identifier.
As of what date were the details pertaining to Kevin Wayne Broder last refreshed?
The information related to the Kevin Wayne Broder, including its address, specialty, and other relevant details, was last updated on 2012-09-05.