Provider Demographics
NPI:1548278294
Name:BROOKS-CANDELA, MARSHA ELLEN (MD)
Entity type:Individual
Prefix:
First Name:MARSHA
Middle Name:ELLEN
Last Name:BROOKS-CANDELA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARSHA
Other - Middle Name:ELLEN
Other - Last Name:BROOKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85653-0188
Mailing Address - Country:US
Mailing Address - Phone:520-682-4111
Mailing Address - Fax:520-818-3630
Practice Address - Street 1:2055 W HOSPITAL DR
Practice Address - Street 2:STE 115
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-7892
Practice Address - Country:US
Practice Address - Phone:520-797-0011
Practice Address - Fax:520-797-7550
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35633207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ248941OtherCIGNA
AZ4124146OtherAETNA
AZ135915OtherHEALTH CHOICE AZ
AZ135915Medicaid
AZ135915001OtherARIZONA PHYSICANS IPA
AZAZ0919450OtherBCBS
AZ2Z4608OtherHEALTH NET OF AZ
AZ2Z4608OtherHEALTH NET OF AZ
AZ135915Medicaid
AZZ111265Medicare PIN
AZP00395634Medicare PIN
AZ248941OtherCIGNA