Provider Demographics
NPI:1679877369
Name:VANBROCKLIN, JAMES DEAN (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DEAN
Last Name:VANBROCKLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36959 S RIBBONWOOD LN
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85739-1210
Mailing Address - Country:US
Mailing Address - Phone:520-818-1925
Mailing Address - Fax:
Practice Address - Street 1:2040 E BURT RD
Practice Address - Street 2:
Practice Address - City:BURT
Practice Address - State:MI
Practice Address - Zip Code:48417-9459
Practice Address - Country:US
Practice Address - Phone:520-241-3522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-10
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301024280208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation