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Duane Thomas Brooks

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NPI Number Detailed Information

Provider Information:

Name: Duane Thomas Brooks
Gender: M
Provider License Number If Given: 5366T

NPI Information:

NPI: 1063415065
Entity Type
(Individual or Organization):
1-ind
Enumeration Date: 5/23/2005

Last Update Date: 11/28/2007

Provider Business Mailing Address:

Address: 110 CHESTNUT ST
Mount Shasta, CA 96067
Phone Number: 5309262033
Fax Number: 5309263722

Provider Business Practice Location Address:

Address: 110 CHESTNUT ST
Mount Shasta, CA 96067
Phone Number: 5309262033
Fax Number: 5309263722

Provider Taxonomy:

Primary: 152W00000X
Secondary (if any): 152W00000X
State: CA

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