Basic Information
Provider Information
NPI: 1760448898
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BROMLEY
FirstName: HOWARD
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5683 S REX RD
Address2:  
City: MEMPHIS
State: TN
PostalCode: 381193821
CountryCode: US
TelephoneNumber: 9013500678
FaxNumber: 9013500677
Practice Location
Address1: 5683 S REX RD
Address2:  
City: MEMPHIS
State: TN
PostalCode: 381193821
CountryCode: US
TelephoneNumber: 9013500678
FaxNumber: 9013500677
Other Information
ProviderEnumerationDate: 04/26/2006
LastUpdateDate: 10/05/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/05/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000X38019TNY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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