Basic Information
| Provider Information | |||||||||
| NPI: | 1952564395 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROCKER | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | ANTHONY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 55 FRUIT ST | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021142621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177244133 | ||||||||
| FaxNumber: | 6176437941 | ||||||||
| Practice Location | |||||||||
| Address1: | 55 FRUIT ST | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021142621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177244133 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2008 | ||||||||
| LastUpdateDate: | 07/28/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | N0661 | TX | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0102X | 2015021905 | MO | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 2086S0102X | MD458636 | PA | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 2086S0102X | D76238 | MD | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 2086S0102X | N0661 | TX | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 2086S0127X | D76238 | MD | Y | Allopathic & Osteopathic Physicians | Surgery | Trauma Surgery |
No ID Information.