Healthcare Provider Details

I. General information

NPI: 1255361838
Provider Name (Legal Business Name): MICHAEL WAGNER BROOK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 PARNASSUS AVE FL 4
SAN FRANCISCO CA
94143-2206
US

IV. Provider business mailing address

470 GREENFIELD AVE SUITE 305
HANFORD CA
93230-3576
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-9035
  • Fax:
Mailing address:
  • Phone: 559-537-0325
  • Fax: 559-537-0327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberG63429
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberG63429
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG63429
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: