MEDICARE: DARYL BROOKS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	741	OK

General Provider Information

NPI Number	:	1043727316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARYL BROOKS

Provider Business Mailing Address
First Line	:	7116 MEADOW LAKE DR
Second Line	:
City	:	YUKON
State	:	OK
Zip	:	73099-6033
Country	:	US
Telephone Number	:	757-768-1782
Fax Number	:

Provider Business Practice Location Address
First Line	:	7116 MEADOW LAKE DR
Second Line	:
City	:	YUKON
State	:	OK
Zip	:	73099-6033
Country	:	US
Telephone Number	:	757-768-1782
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2018
Last Update Date	:	05/29/2019

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Directions to “ DARYL BROOKS ” Practice Location

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