Healthcare Provider Details

I. General information

NPI: 1093763377
Provider Name (Legal Business Name): NATHAN M BROOKS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 11/16/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2352 QUARTER HORSE TRL
OVERGAARD AZ
85933-5319
US

IV. Provider business mailing address

12075 E STATE ROUTE 69
DEWEY AZ
86327-4517
US

V. Phone/Fax

Practice location:
  • Phone: 928-535-3616
  • Fax: 928-532-2156
Mailing address:
  • Phone: 928-772-1673
  • Fax: 928-772-1674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34307
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: