Healthcare Provider Details

I. General information

NPI: 1184694952
Provider Name (Legal Business Name): CHRISTOPHER J M BROOKS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 10/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 JOHNSON ST STE G
HOLLYWOOD FL
33021-6030
US

IV. Provider business mailing address

3800 JOHNSON ST STE G
HOLLYWOOD FL
33021-6030
US

V. Phone/Fax

Practice location:
  • Phone: 954-501-0505
  • Fax: 954-756-7560
Mailing address:
  • Phone: 954-501-0505
  • Fax: 954-756-7560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME92569
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: