Healthcare Provider Details

I. General information

NPI: 1528208097
Provider Name (Legal Business Name): JOHN ANDREW BROOKS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2009
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 W ROCHESTER AVE
SARATOGA WY
82331-5220
US

IV. Provider business mailing address

110 W ROCHESTER AVE
SARATOGA WY
82331-5220
US

V. Phone/Fax

Practice location:
  • Phone: 307-299-3123
  • Fax:
Mailing address:
  • Phone: 307-299-3123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD2019-1042
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberDR0061736
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD61328420
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number12633A
License Number StateWY
# 5
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD 15454
License Number StateHI
# 6
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberP7746
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: