Basic Information
| Provider Information | |||||||||
| NPI: | 1447369483 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROOME | ||||||||
| FirstName: | ROGER | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4258 TAURUS DR | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366934657 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2516619866 | ||||||||
| FaxNumber: | 2563507757 | ||||||||
| Practice Location | |||||||||
| Address1: | 5420 HIGHWAY 90 W | ||||||||
| Address2: | TILLMAN'S CORNER | ||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366194216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2516601505 | ||||||||
| FaxNumber: | 2516609007 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 174400000X | PTH4694 | AL | Y | Other Service Providers | Specialist |
No ID Information.