Provider Demographics
NPI:1629266622
Name:PAUL D BROOKS DPM PA
Entity Type:Organization
Organization Name:PAUL D BROOKS DPM PA
Other - Org Name:BROOKS FOOT & ANKLE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:DAVIS
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:850-479-6250
Mailing Address - Street 1:2201 E NINE MILE RD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-7772
Mailing Address - Country:US
Mailing Address - Phone:850-479-6250
Mailing Address - Fax:850-497-6314
Practice Address - Street 1:2201 E NINE MILE RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-7772
Practice Address - Country:US
Practice Address - Phone:850-479-6250
Practice Address - Fax:850-497-6314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3001213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00288224OtherMEDICARE RR
FL65762OtherBCBS
FL65762OtherBCBS
U90160Medicare UPIN