Healthcare Provider Details

I. General information

NPI: 1447822499
Provider Name (Legal Business Name): MILES BROOKS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2021
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 DEWITT LOOP
FT BELVOIR VA
22060-5285
US

IV. Provider business mailing address

1505 CRYSTAL DR APT 610
ARLINGTON VA
22202-4118
US

V. Phone/Fax

Practice location:
  • Phone: 801-500-5008
  • Fax:
Mailing address:
  • Phone: 801-500-0508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2023043724
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: