Provider Demographics
NPI:1487650495
Name:BROOKS, JEFFREY B (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:B
Last Name:BROOKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 N STONE ST STE B
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-0800
Mailing Address - Country:US
Mailing Address - Phone:386-740-4015
Mailing Address - Fax:386-740-4017
Practice Address - Street 1:999 N STONE ST STE B
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-0800
Practice Address - Country:US
Practice Address - Phone:386-740-4015
Practice Address - Fax:386-736-7998
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0026840174400000X
FLME26840207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL037821600Medicaid
FL037821600Medicaid
FLD57665Medicare UPIN