Provider Demographics
NPI:1073541876
Name:BROOKS, JEFFREY LANE (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:LANE
Last Name:BROOKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6939 SUNRISE BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-3153
Mailing Address - Country:US
Mailing Address - Phone:916-476-1920
Mailing Address - Fax:866-304-6677
Practice Address - Street 1:935 TRANCAS ST STE 2C
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-2944
Practice Address - Country:US
Practice Address - Phone:707-252-4955
Practice Address - Fax:866-304-6677
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG51713208D00000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G517131Medicaid
00G517131Medicare PIN
A04143Medicare UPIN