Provider Demographics
NPI:1619537446
Name:BROCKMANN, DANA MICHELE HOXIE (MD)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:MICHELE HOXIE
Last Name:BROCKMANN
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 1:328 COMMERCIAL RD
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3765
Mailing Address - Country:US
Mailing Address - Phone:909-558-6222
Mailing Address - Fax:
Practice Address - Street 1:328 COMMERCIAL RD
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3765
Practice Address - Country:US
Practice Address - Phone:909-558-6222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-14
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1770342083X0100X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine