Provider Demographics
NPI:1013902832
Name:BROOKER, JEFF Z JR (MD, RETIRED)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:Z
Last Name:BROOKER
Suffix:JR
Gender:M
Credentials:MD, RETIRED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 BERNARDIN AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-2003
Mailing Address - Country:US
Mailing Address - Phone:803-251-8985
Mailing Address - Fax:
Practice Address - Street 1:1625 BERNARDIN AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2003
Practice Address - Country:US
Practice Address - Phone:803-251-8985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2012-01-11
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-04-13
Provider Licenses
StateLicense IDTaxonomies
SC5186207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease