Healthcare Provider Details

I. General information

NPI: 1770550584
Provider Name (Legal Business Name): JOHN SCOTT BROOKS M.D., MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 01/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

559 VINCENT ST ATTN: 21 AMDS/SGPF - AEROSP MEDICINE
PETERSON AFB CO
80914-1540
US

IV. Provider business mailing address

559 VINCENT ST ATTN: 21 AMDS/SGPF - AEROSP MEDICINE
PETERSON AFB CO
80914-1540
US

V. Phone/Fax

Practice location:
  • Phone: 719-556-2273
  • Fax: 866-867-7926
Mailing address:
  • Phone: 719-556-1260
  • Fax: 866-867-7926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number0101229336
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number17869
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: