MEDICARE: DR. JIMMETTE N BROOKS M.D.

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207Q00000X	Family Medicine Physician	MD16412	RI

General Provider Information

NPI Number	:	1487005682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JIMMETTE N BROOKS M.D.

Provider Business Mailing Address
First Line	:	595 WASHINGTON ST
Second Line	:
City	:	COVENTRY
State	:	RI
Zip	:	02816-5476
Country	:	US
Telephone Number	:	401-822-2772
Fax Number	:	401-821-5260

Provider Business Practice Location Address
First Line	:	595 WASHINGTON ST
Second Line	:
City	:	COVENTRY
State	:	RI
Zip	:	02816-5476
Country	:	US
Telephone Number	:	401-822-2772
Fax Number	:	401-821-5260

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

Provider Enumeration Date	:	06/29/2016
Last Update Date	:	12/13/2019

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