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NPI Code Detail

MEDICARE: JOHN R BROOKS MD

MEDICARE:   JOHN R BROOKS  MD
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
1207W00000XOphthalmology PhysicianG57954CA

General Provider Information

NPI Number : 1760589634
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN R BROOKS MD
Provider Business Mailing Address
First Line : 179 CREEKSIDE CT
Second Line :
City : GLENWOOD SPRINGS
State : CO
Zip : 81601-2543
Country : US
Telephone Number : 970-928-8189
Fax Number :
Provider Business Practice Location Address
First Line : 179 CREEKSIDE CT
Second Line :
City : GLENWOOD SPRINGS
State : CO
Zip : 81601-2543
Country : US
Telephone Number : 970-928-8189
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2006
Last Update Date : 02/19/2008

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