Provider Demographics
NPI:1528602885
Name:RONALD D BROOKSHER MD PLLC
Entity Type:Organization
Organization Name:RONALD D BROOKSHER MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:D
Authorized Official - Last Name:BROOKSHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-344-6263
Mailing Address - Street 1:1951 W 25TH ST STE D
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-6924
Mailing Address - Country:US
Mailing Address - Phone:928-344-6263
Mailing Address - Fax:928-317-0544
Practice Address - Street 1:1951 W 25TH ST STE D
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6924
Practice Address - Country:US
Practice Address - Phone:928-344-6263
Practice Address - Fax:928-317-0544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-30
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty