Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 05667 | AZ |
N | 111NI0900X | Internist | 05667 | AZ |
Y | 207RA0401X | Internist - Addiction Medicine | 005667 | AZ |
NPI | 1881823250 |
---|---|
Provider Name | Charles Christopher Brooker |
First Address | Phoenix, AZ 85016-5344 |
Second Address | Peoria, AZ 85382-2124 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2009 |
Last Update Date | 30/09/2020 |