Provider Demographics
NPI:1215912407
Name:COFIELD, BROOKS G II (DO)
Entity type:Individual
Prefix:DR
First Name:BROOKS
Middle Name:G
Last Name:COFIELD
Suffix:II
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 SE OAK ST
Mailing Address - Street 2:STE B
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4117
Mailing Address - Country:US
Mailing Address - Phone:503-648-6159
Mailing Address - Fax:503-648-8235
Practice Address - Street 1:545 SE OAK ST
Practice Address - Street 2:STE B
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4117
Practice Address - Country:US
Practice Address - Phone:503-648-6159
Practice Address - Fax:503-648-8235
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO12922174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR169839Medicaid
OR169839Medicaid
ORR0000BKBKPMedicare PIN