Provider Demographics
NPI:1952585887
Name:BROOKS, SHAWN PAUL (SFIDC)
Entity Type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:PAUL
Last Name:BROOKS
Suffix:
Gender:M
Credentials:SFIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USS DECATUR
Mailing Address - Street 2:DDG 73
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96663-1290
Mailing Address - Country:US
Mailing Address - Phone:619-556-4660
Mailing Address - Fax:
Practice Address - Street 1:USS DECATUR
Practice Address - Street 2:DDG 73
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96663-1290
Practice Address - Country:US
Practice Address - Phone:619-556-4660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman