Provider Demographics
NPI:1821024415
Name:BROOKER, KIMBERLY THAYER (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:THAYER
Last Name:BROOKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 S 336TH ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6328
Mailing Address - Country:US
Mailing Address - Phone:253-838-6180
Mailing Address - Fax:253-838-6418
Practice Address - Street 1:1717 S J ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4933
Practice Address - Country:US
Practice Address - Phone:253-426-6660
Practice Address - Fax:253-426-6250
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA218790207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0229706OtherLIWA
WA8466062Medicaid
WA2241THOtherBSWA
WA8466062Medicaid
WAG8871250Medicare PIN
WATHA1977Medicare UPIN
WAP00370084Medicare PIN