Healthcare Provider Details

I. General information

NPI: 1871598201
Provider Name (Legal Business Name): REGINALD JOHN BROOKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 07/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 BUTTERNUT DR STE B
GREENVILLE SC
29605-4653
US

IV. Provider business mailing address

1 INDEPENDENCE PT SUITE 212
GREENVILLE SC
29615-4545
US

V. Phone/Fax

Practice location:
  • Phone: 864-298-2826
  • Fax: 864-672-7764
Mailing address:
  • Phone: 864-797-6044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number7813
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: