Provider Demographics
NPI:1184694952
Name:BROOKS, CHRISTOPHER J M (MD)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:J M
Last Name:BROOKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3800 JOHNSON ST
Mailing Address - Street 2:STE G
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6030
Mailing Address - Country:US
Mailing Address - Phone:954-501-0505
Mailing Address - Fax:954-756-7560
Practice Address - Street 1:3800 JOHNSON ST
Practice Address - Street 2:STE G
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6030
Practice Address - Country:US
Practice Address - Phone:954-501-0505
Practice Address - Fax:954-756-7560
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2016-10-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME92569208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272091400Medicaid
FL01638ZMedicare ID - Type Unspecified
FL272091400Medicaid
PAI17766Medicare UPIN