Healthcare Provider Details

I. General information

NPI: 1407826621
Provider Name (Legal Business Name): TIMOTHY SCOTT BROOKS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 11/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 N FRANKLIN ST
TITUSVILLE PA
16354-1761
US

IV. Provider business mailing address

122 N FRANKLIN ST
TITUSVILLE PA
16354-1761
US

V. Phone/Fax

Practice location:
  • Phone: 814-827-2841
  • Fax: 814-827-0746
Mailing address:
  • Phone: 814-827-2841
  • Fax: 814-827-0746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberSC003804R
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: