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General NPI Number Information
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NPI Number | 1457363160
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Entity Type | Organization
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Legal Business Name | BROOKS & POTTINGER, M.D., P.A.
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Dates
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Enumeration Date | 08/12/2006
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Last Update Date | 09/02/2011
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Provider Practice Location Address
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Address Line | 850 W PLYMOUTH AVENUE
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City | DELAND
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State | FL
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Zip | 32720
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Country | US
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Telephone | 386-736-6110
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Fax | 386-736-7998
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Provider Business Mailing Address
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Address Line | 850 W PLYMOUTH AVENUE
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City | DELAND
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State | FL
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Zip | 32720
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Country | US
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Telephone | 386-736-6110
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Fax | 386-736-7998
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEFFREY B BROOKS
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Credential | M.D.
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Telephone | 386-736-6110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | 1053372
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | ME103639
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME0026840
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License Number State | FL
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