Provider Demographics
NPI:1598560369
Name:UDALL, BROOKS CHRISTOPHER
Entity type:Individual
Prefix:
First Name:BROOKS
Middle Name:CHRISTOPHER
Last Name:UDALL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3331 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:THATCHER
Mailing Address - State:AZ
Mailing Address - Zip Code:85552-5628
Mailing Address - Country:US
Mailing Address - Phone:928-651-3165
Mailing Address - Fax:
Practice Address - Street 1:3331 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:THATCHER
Practice Address - State:AZ
Practice Address - Zip Code:85552-5628
Practice Address - Country:US
Practice Address - Phone:928-651-3165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program