Healthcare Provider Details

I. General information

NPI: 1487727814
Provider Name (Legal Business Name): RONALD D BROOKSHER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 01/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1951 W 25TH STREET SUITE D
YUMA AZ
85364
US

IV. Provider business mailing address

1951 W 25TH STREET SUITE D
YUMA AZ
85364
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 TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number20396
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number20396
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: