Provider Demographics
NPI:1174562672
Name:BROCKWELL, JANET M (MD)
Entity type:Individual
Prefix:DR
First Name:JANET
Middle Name:M
Last Name:BROCKWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65555 MATHEWS RD
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-9715
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:66737 TOLAND DR
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-1155
Practice Address - Country:US
Practice Address - Phone:740-439-1371
Practice Address - Fax:740-432-0248
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-040074207P00000X
FLME80964207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0373500Medicaid
OH0373500Medicaid