Healthcare Provider Details

I. General information

NPI: 1376559641
Provider Name (Legal Business Name): DAWN S. BROOKE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 05/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10401 ANDERSON MILL #110B
AUSTIN TX
78750-2579
US

IV. Provider business mailing address

PO BOX 26726
AUSTIN TX
78755-0726
US

V. Phone/Fax

Practice location:
  • Phone: 512-250-5571
  • Fax: 512-335-3068
Mailing address:
  • Phone: 512-407-8686
  • Fax: 512-421-4489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberH6073
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: