Healthcare Provider Details

I. General information

NPI: 1528602885
Provider Name (Legal Business Name): RONALD D BROOKSHER MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2019
Last Update Date: 11/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1951 W 25TH ST STE D
YUMA AZ
85364-6924
US

IV. Provider business mailing address

1951 W 25TH ST STE D
YUMA AZ
85364-6924
US

V. Phone/Fax

Practice location:
  • Phone: 928-344-6263
  • Fax: 928-317-0544
Mailing address:
  • Phone: 928-344-6263
  • Fax: 928-317-0544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: RONALD D BROOKSHER
Title or Position: OWNER
Credential: MD
Phone: 209-344-6263