Healthcare Provider Details

I. General information

NPI: 1053066407
Provider Name (Legal Business Name): ZECHARIAH STEPHEN BROOKE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2022
Last Update Date: 06/17/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MERCY CIRCLE NMRTC CAMP PENDLETON
OCEANSIDE CA
92055
US

IV. Provider business mailing address

PO BOX 555320
CAMP PENDLETON CA
92055-5320
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-1288
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number0101283424
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: