Healthcare Provider Details

I. General information

NPI: 1598285132
Provider Name (Legal Business Name): JARED BROOKS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2017
Last Update Date: 07/06/2020
Certification Date: 07/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WMU SCHOOL OF MEDICINE 1000 OAKLAND DRIVE
KALAMAZOO MI
49008
US

IV. Provider business mailing address

101 THE CITY DR S BLDG 1
ORANGE CA
92868-3201
US

V. Phone/Fax

Practice location:
  • Phone: 269-337-4400
  • Fax:
Mailing address:
  • Phone: 714-456-6411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number207ZP0101X
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4351046918
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: