Healthcare Provider Details

I. General information

NPI: 1962461053
Provider Name (Legal Business Name): DAREN RICHARD BROOKS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 07/21/2022
Certification Date: 07/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 561 BOX 178
FPO AP
96310-0012
JP

IV. Provider business mailing address

222 SITARA LN
SAINT JOHNS FL
32259-1220
US

V. Phone/Fax

Practice location:
  • Phone: 01181827793859
  • Fax:
Mailing address:
  • Phone: 904-907-0890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number01061380A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME140292
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: