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Contact Information

JOHN M BROCKENBROUGH, MD
12303 NE 130TH LN STE 400
KIRKLAND, WA98034-3041
 Phone: 425-899-4590
 Fax: 425-899-4591
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Otolaryngology

207Y00000X 04 Physician/Otolaryngology
Indicates primary specialty

NPI Profile & details for JOHN M BROCKENBROUGH · (Male)

NPI # 1134154131
Status Active
Credentials MD
Entity Individual
Enumeration date 07/11/2006
Last updated 12/12/2017 - About 8 years ago
Sole proprietor 1 No
Identifiers
  • IL License # 036101927
  • IL Medicaid 6447860011
Hospital affiliation(s)
  • EVERGREEN HOSPITAL MEDICAL CENTER - (Acute Care)
    12040 NE 128TH STREET
    KIRKLAND, WA 98034
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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