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General NPI Number Information
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NPI Number | 1073541876
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Entity Type | Individual
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Provider Name | JEFFREY LANE BROOKS MD
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Gender | Male
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Dates
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Enumeration Date | 06/29/2006
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Last Update Date | 02/29/2024
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Provider Practice Location Address
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Address Line | 935 TRANCAS ST STE 2C
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City | NAPA
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State | CA
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Zip | 94558-2944
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Country | US
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Telephone | 707-252-4955
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Fax | 866-304-6677
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Provider Business Mailing Address
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Address Line | 6939 SUNRISE BLVD STE 106
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City | CITRUS HEIGHTS
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State | CA
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Zip | 95610-3153
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Country | US
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Telephone | 916-476-1920
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Fax | 866-304-6677
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | G51713
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | G51713
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License Number State | CA
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