Provider Demographics
NPI:1427346931
Name:SCOTT DAVID BROOK MD INC.
Entity type:Organization
Organization Name:SCOTT DAVID BROOK MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BROOK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-619-5450
Mailing Address - Street 1:1180 N INDIAN CANYON DR
Mailing Address - Street 2:SUITE E-218
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-4800
Mailing Address - Country:US
Mailing Address - Phone:714-619-5450
Mailing Address - Fax:714-505-7540
Practice Address - Street 1:1180 N INDIAN CANYON DR
Practice Address - Street 2:SUITE E-218
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4800
Practice Address - Country:US
Practice Address - Phone:714-619-5450
Practice Address - Fax:714-505-7540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-18
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A116376OtherMEDICAL LICSENSE