Provider Demographics
NPI:1184612186
Name:BROOKS, PAUL DAVIS (DPM)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:DAVIS
Last Name:BROOKS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 E NINE MILE RD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-7772
Mailing Address - Country:US
Mailing Address - Phone:850-479-6250
Mailing Address - Fax:850-497-6314
Practice Address - Street 1:2201 E NINE MILE RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-7772
Practice Address - Country:US
Practice Address - Phone:850-479-6250
Practice Address - Fax:850-497-6314
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3001213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL202919095OtherTAX ID
FL65762OtherBCBS
FL65762OtherBCBS
FL202919095OtherTAX ID