Healthcare Provider Details

I. General information

NPI: 1679815443
Provider Name (Legal Business Name): BROOKE MINER DISMUKES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BROOKE MICHELE MINER

II. Dates (important events)

Enumeration Date: 03/20/2013
Last Update Date: 05/11/2021
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4225 LAPALCO BLVD
MARRERO LA
70072-4324
US

IV. Provider business mailing address

1514 JEFFERSON HWY
NEW ORLEANS LA
70121-2429
US

V. Phone/Fax

Practice location:
  • Phone: 504-391-7337
  • Fax: 504-398-7213
Mailing address:
  • Phone: 504-842-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD465276
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number43249
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number325714
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: