Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | E5088 | CA |
N | 222Z00000X | Podiatrist | E5088 | CA |
N | 213EP0504X | Public Medicine | E5088 | CA |
N | 213EP1101X | Primary Podiatric Medicine | E5088 | CA |
N | 111NR0200X | Radiology | E5088 | CA |
N | 213ER0200X | Radiology | E5088 | CA |
N | 2081S0010X | Sports Medicine | E5088 | CA |
N | 213ES0000X | Sports Medicine | E5088 | CA |
Y | 213ES0103X | Foot & Ankle Surgery | E5088 | CA |
N | 213ES0131X | Foot Surgery | E5088 | CA |
NPI | 1790030393 |
---|---|
Provider Name | Dr. Brooke M Dix |
First Address | Mountain View, CA 94040-4200 |
Second Address | Mountain View, CA 94040-4200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2012 |
Last Update Date | 15/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E-5088 | LICENSE (01) | CA |