Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 155597-1 | NY |
NPI | 1043273279 |
---|---|
Provider Name | Dr. Walter S Brooks |
First Address | Rochester, NY 14626-3919 |
Second Address | Rochester, NY 14626-3919 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01523748-09 | (05) | NY |
E15597 | (02) | NY |