Healthcare Provider Details

I. General information

NPI: 1548729668
Provider Name (Legal Business Name): JACK EWAN BROOKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY HOSPITALS CASE MEDICAL CENTER 11100 EUCLID AVE
CLEVELAND OH
44106
US

IV. Provider business mailing address

UNIVERSITY HOSPITALS CASE MEDICAL CENTER 11100 EUCLID AVE
CLEVELAND OH
44106
US

V. Phone/Fax

Practice location:
  • Phone: 216-844-4780
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number79690
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: