Provider Demographics
NPI:1598798480
Name:BROOKS, MARK F (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:F
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 1:7210 40TH ST W
Mailing Address - Street 2:STE 100
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4318
Mailing Address - Country:US
Mailing Address - Phone:253-564-0170
Mailing Address - Fax:
Practice Address - Street 1:7210 40TH ST W
Practice Address - Street 2:STE 100
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4318
Practice Address - Country:US
Practice Address - Phone:253-564-0170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00031603207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0126533OtherSTATE L&I
WA8928712OtherSTATE CRIME VICTIMS
WA8937675OtherSTATE CRIME VICTIMS
WA0163664OtherSTATE L&I
WA8154320Medicaid
WA80138476OtherMEDICARE RAILROAD
WAD00734Medicare UPIN
WA8154320Medicaid
WAGAB08525Medicare PIN
WA8928712OtherSTATE CRIME VICTIMS