NPI 1407878853 · live from the CMS NPI Registry
Thomas W Broderick, M.D.
Radiology, Diagnostic Radiology in Boise, ID. National Provider Identifier 1407878853, active.
NPI record
| NPI | 1407878853 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Radiology, Diagnostic Radiology 2085R0202X |
| Practice location | 190 E Bannock St, Boise, ID 83712 |
| Practice phone | 208-381-2094 |
| Mailing address | Po Box 9696, Boise, ID 83707 |
| Enumerated | July 24, 2006 |
| Last updated | July 8, 2007 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Radiology, Diagnostic Radiology primary | 2085R0202X | M6258 (ID) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.