Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 5186 | SC |
NPI | 1013902832 |
---|---|
Provider Name | Jeff Z Brooker JR. |
First Address | Columbia, SC 29204-2003 |
Second Address | Columbia, SC 29204-2003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2005 |
Last Update Date | 11/01/2012 |