Provider Demographics
NPI:1255377602
Name:BROOKS, HARRY WARD JR (MD)
Entity type:Individual
Prefix:
First Name:HARRY
Middle Name:WARD
Last Name:BROOKS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:H
Other - Middle Name:WARD
Other - Last Name:BROOKS
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:25150 HANCOCK AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-5988
Mailing Address - Country:US
Mailing Address - Phone:951-698-4660
Mailing Address - Fax:951-698-4659
Practice Address - Street 1:25150 HANCOCK AVE STE 200
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5988
Practice Address - Country:US
Practice Address - Phone:951-698-4660
Practice Address - Fax:951-698-4659
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG38991207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G389910Medicaid
CA00G389911Medicare PIN
A47663Medicare UPIN
CA00G389910Medicaid
CAG38991Medicare PIN