DR. MARK BRODEUR MD NPI 1952389538

NPI Information

NPI: 1952389538
Provider Name: DR. MARK BRODEUR, MD
Classification: Emergency Medicine - 207PE0004X
Entity Type: Individual

Specialization: Emergency Medical Services

PECOS Registration: Yes

Address:
3625 UNIVERSITY BLVD S
EMERGENCY DEPT
JACKSONVILLE, FL
ZIP 32216
Phone: (904) 346-3606
Get Directions

DR. Mark Brodeur, MD is an emergency medical services emergency medicine in Jacksonville, FL with 23 years of experience. The provider is an emergency medicine physician who specializes in non-hospital based emergency medical services (e.g., disaster site, accident scene, transport vehicle, etc.) to provide pre-hospital assessment, treatment, and transport patients. DR. Mark Brodeur, MD NPI is 1952389538. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: EASTERN VIRGINIA MEDICAL SCHOOL
Graduation Year:2001

The provider's business location address is:

3625 UNIVERSITY BLVD S
EMERGENCY DEPT
JACKSONVILLE, FL
ZIP 32216-207
Phone: (904) 346-3606
Fax: (904) 346-0113

The NPI 1952389538 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 1/4/2006 and was last updated on 7/30/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207PE0004X	Emergency Medicine	Emergency Medical Services	ME0090285	FLORIDA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	P00139639	OTHER	FLORIDA	RRMCR
2	269864100	OTHER	FLORIDA	FLORIDA MEDICAID
3	44098	OTHER	FLORIDA	BCBS
4	P00139639	OTHER		RAILROAD MEDICARE
5	44098Z	MEDICARE ID-TYPE UNSPECIFIED	FLORIDA
6	787365756A	MEDICAID	GEORGIA
7	269864100	MEDICAID	FLORIDA
8	H88014	MEDICARE UPIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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