Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0105X | Surgery of the Hand | 20396 | AZ |
Y | 2086S0122X | Plastic and Reconstructive Surgery | 20396 | AZ |
NPI | 1487727814 |
---|---|
Provider Name | Ronald D Brooksher |
First Address | Yuma, AZ 85364 |
Second Address | Yuma, AZ 85364 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2006 |
Last Update Date | 17/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F09602 | (02) |