Provider Demographics
NPI:1750336913
Name:BROOKE, MARVIN M (MD)
Entity type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:M
Last Name:BROOKE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8441 SE 68TH ST
Mailing Address - Street 2:PMB 198
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-5235
Mailing Address - Country:US
Mailing Address - Phone:253-841-3168
Mailing Address - Fax:253-841-3169
Practice Address - Street 1:1600 E JEFFERSON ST
Practice Address - Street 2:STE A4
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5698
Practice Address - Country:US
Practice Address - Phone:206-302-7747
Practice Address - Fax:206-302-7748
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2010-09-23
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Provider Licenses
StateLicense IDTaxonomies
WA15202208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAA04142Medicare UPIN
WAAB05541Medicare PIN
WA8869156Medicare PIN
WA250009593Medicare PIN