Provider Demographics
NPI:1962461053
Name:BROOKS, DAREN RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:DAREN
Middle Name:RICHARD
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 1:222 SITARA LN
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-1220
Mailing Address - Country:US
Mailing Address - Phone:904-907-0890
Mailing Address - Fax:
Practice Address - Street 1:PSC 561 BOX 178
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96310-0012
Practice Address - Country:JP
Practice Address - Phone:0118182-779-3859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01061380A2083A0100X
FLME140292207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine