MEDICARE: MARK F BROOKS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD00031603	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	80138476	OTHER	WA	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0126533	OTHER	WA	STATE L&I
2	8928712	OTHER	WA	STATE CRIME VICTIMS
3	8937675	OTHER	WA	STATE CRIME VICTIMS
4	0163664	OTHER	WA	STATE L&I
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598798480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK F BROOKS MD

Provider Business Mailing Address
First Line	:	7210 40TH ST W
Second Line	:	STE 100
City	:	UNIVERSITY PLACE
State	:	WA
Zip	:	98466-4318
Country	:	US
Telephone Number	:	253-564-0170
Fax Number	:

Provider Business Practice Location Address
First Line	:	7210 40TH ST W
Second Line	:	STE 100
City	:	UNIVERSITY PLACE
State	:	WA
Zip	:	98466-4318
Country	:	US
Telephone Number	:	253-564-0170
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	11/16/2010

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Directions to “ MARK F BROOKS MD” Practice Location

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