Provider Demographics
NPI:1124515119
Name:JEFFREY BROOKS MD INC
Entity type:Organization
Organization Name:JEFFREY BROOKS MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:LANE
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-252-4955
Mailing Address - Street 1:935 TRANCAS ST STE 2C
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-2944
Mailing Address - Country:US
Mailing Address - Phone:707-252-4955
Mailing Address - Fax:866-304-6677
Practice Address - Street 1:935 TRANCAS ST STE 2C
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-2944
Practice Address - Country:US
Practice Address - Phone:707-252-4955
Practice Address - Fax:866-304-6677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-16
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG517132086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty