Healthcare Provider Details

I. General information

NPI: 1285625723
Provider Name (Legal Business Name): PHILLIP MOHLER BROOKS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2524 TRAMWAY TERRACE CT NE
ALBUQUERQUE NM
87122-2317
US

IV. Provider business mailing address

2524 TRAMWAY TERRACE CT NE
ALBUQUERQUE NM
87122-2317
US

V. Phone/Fax

Practice location:
  • Phone: 505-856-1936
  • Fax: 303-422-9474
Mailing address:
  • Phone: 505-856-1936
  • Fax: 303-422-9474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number88128
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: