MEDICARE: MR. SHAWN PAUL BROOKS SFIDC

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	1710I1002X	Independent Duty Corpsman

General Provider Information

NPI Number	:	1952585887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SHAWN PAUL BROOKS SFIDC

Provider Business Mailing Address
First Line	:	USS DECATUR
Second Line	:	DDG 73
City	:	FPO
State	:	AP
Zip	:	96663-1290
Country	:	US
Telephone Number	:	619-556-4660
Fax Number	:

Provider Business Practice Location Address
First Line	:	USS DECATUR
Second Line	:	DDG 73
City	:	FPO
State	:	AP
Zip	:	96663-1290
Country	:	US
Telephone Number	:	619-556-4660
Fax Number	:

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

Provider Enumeration Date	:	12/27/2007
Last Update Date	:	08/17/2009

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