Provider Demographics
NPI:1750416608
Name:JEFFY, BROOKE GRANT (MD)
Entity type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:GRANT
Last Name:JEFFY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:SHANNON
Other - Last Name:GRANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9500 E IRONWOOD SQUARE DR STE 110
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4582
Mailing Address - Country:US
Mailing Address - Phone:480-948-8400
Mailing Address - Fax:480-948-8401
Practice Address - Street 1:9500 E IRONWOOD SQUARE DR STE 110
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4582
Practice Address - Country:US
Practice Address - Phone:480-948-8400
Practice Address - Fax:480-948-8401
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ46788207N00000X
KY40450207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ773773Medicaid
AZ773773Medicaid