Provider Demographics
NPI:1487677175
Name:BROOKE, DANIEL C (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:C
Last Name:BROOKE
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 1:2600 WILSON ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MILES CITY
Mailing Address - State:MT
Mailing Address - Zip Code:59301-5094
Mailing Address - Country:US
Mailing Address - Phone:406-233-2520
Mailing Address - Fax:406-233-4062
Practice Address - Street 1:2600 WILSON ST STE 1
Practice Address - Street 2:
Practice Address - City:MILES CITY
Practice Address - State:MT
Practice Address - Zip Code:59301-5094
Practice Address - Country:US
Practice Address - Phone:406-233-2520
Practice Address - Fax:406-233-4062
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4617207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT200022649OtherRAILROAD MEDICARE
MT1069930001OtherDMERC REGION D
MT1841474087OtherDMERC
MT1487677175Medicaid
MT000083909Medicare ID - Type Unspecified
MT1487677175Medicaid