Provider Demographics
NPI:1790030393
Name:DIX, BROOKE M (DPM)
Entity Type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:M
Last Name:DIX
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:305 SOUTH DR
Mailing Address - Street 2:6
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-4200
Mailing Address - Country:US
Mailing Address - Phone:650-215-8722
Mailing Address - Fax:650-964-0720
Practice Address - Street 1:305 SOUTH DR
Practice Address - Street 2:6
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-4200
Practice Address - Country:US
Practice Address - Phone:650-215-8722
Practice Address - Fax:650-964-0720
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAE5088213E00000X, 213EP1101X, 213EP0504X, 213ES0000X, 213ER0200X, 213ES0131X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213EP0504XPodiatric Medicine & Surgery Service ProvidersPodiatristPublic Medicine
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE-5088OtherLICENSE
CACA111489Medicare PIN
CACA110706Medicare PIN