Provider Demographics
NPI:1518282417
Name:BROOKS, TIMOTHY DUANE (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:DUANE
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:PO BOX 11247
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32524-1247
Mailing Address - Country:US
Mailing Address - Phone:850-476-7707
Mailing Address - Fax:850-995-9440
Practice Address - Street 1:4806 ROSEMONT PL
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-7909
Practice Address - Country:US
Practice Address - Phone:850-476-7707
Practice Address - Fax:850-995-9440
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-02
Last Update Date:2010-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME43585208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice