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General NPI Number Information
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NPI Number | 1255361838
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Entity Type | Individual
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Provider Name | MICHAEL WAGNER BROOK MD
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Gender | Male
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 06/03/2025
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Provider Practice Location Address
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Address Line | 521 PARNASSUS AVE FL 4
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City | SAN FRANCISCO
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State | CA
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Zip | 94143-2206
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Country | US
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Telephone | 415-476-9035
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Fax |
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Provider Business Mailing Address
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Address Line | 470 GREENFIELD AVE SUITE 305
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City | HANFORD
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State | CA
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Zip | 93230-3576
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Country | US
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Telephone | 559-537-0325
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Fax | 559-537-0327
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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 | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | G63429
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | G63429
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | G63429
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License Number State | CA
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