Basic Information
| Provider Information | |||||||||
| NPI: | 1033169339 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BROCHERT | ||||||||
| FirstName: | ADAM | ||||||||
| MiddleName: | JAMES | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 503 EISENHOWER DR | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314062668 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123556255 | ||||||||
| FaxNumber: | 9123556256 | ||||||||
| Practice Location | |||||||||
| Address1: | 74785 US HIGHWAY 111 STE 101 | ||||||||
| Address2: | |||||||||
| City: | INDIAN WELLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7608363835 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2006 | ||||||||
| LastUpdateDate: | 08/29/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | A92244 | CA | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 052147 | GA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 00A922440 | 05 | CA | MEDICAID | 00A922440 | 01 | CA | BLUE SHIELD OF CA | OTHER |