Healthcare Provider Details

I. General information

NPI: 1770825523
Provider Name (Legal Business Name): MEGHAN LEIGH BROOKING D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2013
Last Update Date: 11/01/2022
Certification Date: 11/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N FLAMINGO RD STE 210
PEMBROKE PINES FL
33028-1009
US

IV. Provider business mailing address

15280 NW 79TH CT STE 200
MIAMI LAKES FL
33016-5873
US

V. Phone/Fax

Practice location:
  • Phone: 954-438-1015
  • Fax: 954-450-0636
Mailing address:
  • Phone: 305-558-3724
  • Fax: 786-907-4485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberOS17526
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License NumberOS018419
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: