=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972890630
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | H. WARD BROOKS, M.D. APC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/01/2011
-----------------------------------------------------
Last Update Date | 09/20/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 521 E ELDER ST #105
-----------------------------------------------------
City | FALLBROOK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92028-3081
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-728-5851
-----------------------------------------------------
Fax | 760-728-0703
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 521 E ELDER ST #105
-----------------------------------------------------
City | FALLBROOK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92028-3081
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-728-5851
-----------------------------------------------------
Fax | 760-728-0703
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. H, WARD BROOKS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 760-728-5851
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | G38991
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------