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General NPI Number Information
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NPI Number | 1053494146
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Entity Type | Organization
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Legal Business Name | BROOK MEDICAL PLLC
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 02/10/2015
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Provider Practice Location Address
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Address Line | 1281 E. IRON EAGLE DR
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City | EAGLE
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State | ID
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Zip | 83616-9117
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Country | US
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Telephone | 208-939-5535
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Fax | 208-939-5536
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Provider Business Mailing Address
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Address Line | 1281 E. IRON EAGLE DR
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City | EAGLE
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State | ID
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Zip | 83616-9117
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Country | US
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Telephone | 208-939-5535
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Fax | 208-939-5536
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Authorized Official
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Title or Position | OWNER
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Name | DR. VICKI L WOOLL
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Credential | MD
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Telephone | 208-939-5535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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