Basic Information
| Provider Information | |||||||||
| NPI: | 1013459700 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TARA L BRODKIN MD PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 64568 | ||||||||
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| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850824568 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3184244008 | ||||||||
| FaxNumber: | 8552301466 | ||||||||
| Practice Location | |||||||||
| Address1: | 9070 E DESERT COVE AVE | ||||||||
| Address2: | STE 102 | ||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852606227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808602322 | ||||||||
| FaxNumber: | 4808602433 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2016 | ||||||||
| LastUpdateDate: | 12/22/2017 | ||||||||
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| AuthorizedOfficialLastName: | BRODKIN-GAUER | ||||||||
| AuthorizedOfficialFirstName: | TARA | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4808602322 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.