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General NPI Number Information
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NPI Number | 1124515119
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Entity Type | Organization
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Legal Business Name | JEFFREY BROOKS MD INC
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Dates
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Enumeration Date | 04/16/2018
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Last Update Date | 03/31/2020
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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 | 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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Authorized Official
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Title or Position | PRESIDENT
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Name | JEFFREY LANE BROOKS
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Credential | MD
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Telephone | 707-252-4955
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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