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General NPI Number Information
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NPI Number | 1376238519
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Entity Type | Individual
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Provider Name | JOSEPH DONALD BROOKS
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Gender | Male
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Dates
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Enumeration Date | 04/05/2023
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Last Update Date | 09/30/2024
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Provider Practice Location Address
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Address Line | 85 HERRICK ST
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City | BEVERLY
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State | MA
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Zip | 01915-1790
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Country | US
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Telephone | 978-922-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 158 GRANT AVE
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City | MEDFORD
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State | MA
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Zip | 02155-2765
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Country | US
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Telephone | 603-801-5656
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA100249
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License Number State | MA
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