| Doctor Name: | BRUCE BROKAW |
| NPI Number: | 1316159072 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | P.A.-C. |
| License Number: | 0170 |
| Business Practice Address: | 400 Captain Thomas Road Wells, ME - 040907552 |
| Business Phone Number: | 6037403293 |
| Business Fax Number: | |
| Mailing Address: | 400 Captain Thomas Rd, Wells MAINE |
| State: | ME |
| Postal Code: | 04090 |
| Phone Number: | 6037403293 |
| Fax Number: | |
| NPI Enumeration Date: | 05/04/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 0170 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NH |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |