Provider Demographics
NPI:1972069359
Name:DR JEFFREY BROOKS PC
Entity Type:Organization
Organization Name:DR JEFFREY BROOKS PC
Other - Org Name:DR JEFFREY BROOKS PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING DEPT. MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOY
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-244-2441
Mailing Address - Street 1:12910 SHELBYVILLE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-2404
Mailing Address - Country:US
Mailing Address - Phone:502-244-2441
Mailing Address - Fax:502-996-8282
Practice Address - Street 1:618 N NEW BALLAS RD APT 409
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6767
Practice Address - Country:US
Practice Address - Phone:314-580-0199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-11
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty