Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | OS004539 | FL |
Y | 207Q00000X | Family Doctor | OS4539 | FL |
NPI | 1134284177 |
---|---|
Provider Name | Francis W Brooks |
First Address | Orlando, FL 32825-8534 |
Second Address | Lake Mary, FL 32746-2000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2006 |
Last Update Date | 10/12/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D60659 | (02) | FL |
OS005230L | PA MEDICAL LICENSE (01) | PA |
OS4539 | FLORIDA MEDICAL LICENSE (01) | FL |