Provider Demographics
NPI:1093017774
Name:BROOKS MANAGEMENT
Entity Type:Organization
Organization Name:BROOKS MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:C
Authorized Official - Last Name:JAWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-755-2255
Mailing Address - Street 1:2919 26TH ST W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-3737
Mailing Address - Country:US
Mailing Address - Phone:941-755-2255
Mailing Address - Fax:941-756-4465
Practice Address - Street 1:2919 26TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-3737
Practice Address - Country:US
Practice Address - Phone:941-755-2255
Practice Address - Fax:941-756-4465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME44267207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL068779100Medicaid
FL068779100Medicaid
FL41221Medicare PIN