Provider Demographics
NPI:1134108152
Name:BROOKS, MARC HARLOW (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:HARLOW
Last Name:BROOKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:7245 E OSBORN RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6443
Mailing Address - Country:US
Mailing Address - Phone:480-994-5012
Mailing Address - Fax:480-990-7364
Practice Address - Street 1:7245 E OSBORN RD
Practice Address - Street 2:SUITE 4
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85257-6443
Practice Address - Country:US
Practice Address - Phone:480-994-5012
Practice Address - Fax:480-990-7364
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2011-12-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ12937207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ214536Medicaid
AZD36597Medicare UPIN
AZ214536Medicaid