Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | G51713 | CA |
N | 208600000X | Surgeon | G51713 | CA |
Y | 2086S0129X | Vascular Surgeon | G51713 | CA |
NPI | 1073541876 |
---|---|
Provider Name | Dr. Jeffrey Lane Brooks |
First Address | Napa, CA 94558-2944 |
Second Address | Napa, CA 94558-2944 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 31/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G517131 | (05) | CA |
A04143 | (02) |