Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | ME75946 | FL |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | ME75946 | FL |
NPI | 1922026335 |
---|---|
Provider Name | Charles R Brooker |
First Address | Miami Lakes, FL 33016-5861 |
Second Address | Winter Haven, FL 33881-3155 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 24/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
255392-900 | (05) | FL |
G75481 | (02) |