| Organization Name: | JEFFREY N BRODER MD PC |
| NPI Number: | 1679567259 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JEFFREY N BRODER (MEDICAL DIRECTOR) |
| Mailing Address: | 1201 West Ave North Augusta |
| State: | SC US |
| Postal Code: | 298413350 |
| Phone Number: | 8032791030 |
| Fax Number: | 8032781344 |
| NPI Enumeration Date: | 09/09/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 15157 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | SC |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |