Provider Demographics
NPI:1972653566
Name:BROOKS, NAOMI BETH (MD)
Entity Type:Individual
Prefix:DR
First Name:NAOMI
Middle Name:BETH
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NAOMI
Other - Middle Name:BETH
Other - Last Name:CREEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3109 S MERIDIAN RD
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-7088
Mailing Address - Country:US
Mailing Address - Phone:208-888-0660
Mailing Address - Fax:208-567-5973
Practice Address - Street 1:3109 S MERIDIAN RD
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-7088
Practice Address - Country:US
Practice Address - Phone:208-888-0660
Practice Address - Fax:208-567-5973
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01058178A207N00000X
IDM-11311207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology