Provider Demographics
NPI:1306927249
Name:BROOKS, MARK G (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:G
Last Name:BROOKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:10000 W COLONIAL DR
Mailing Address - Street 2:SUITE 187
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-3498
Mailing Address - Country:US
Mailing Address - Phone:407-578-6610
Mailing Address - Fax:407-578-2247
Practice Address - Street 1:10000 W COLONIAL DR
Practice Address - Street 2:SUITE 187
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-3498
Practice Address - Country:US
Practice Address - Phone:407-578-6610
Practice Address - Fax:407-578-2247
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME70398207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL31937OtherBCBS
FLK3161Medicare ID - Type Unspecified
FL31937OtherBCBS