Provider Demographics
NPI:1265403745
Name:BROOKING, FREDRICK TODD (MD)
Entity type:Individual
Prefix:DR
First Name:FREDRICK
Middle Name:TODD
Last Name:BROOKING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14402 E SPRAGUE AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-2167
Mailing Address - Country:US
Mailing Address - Phone:509-922-2625
Mailing Address - Fax:509-922-4001
Practice Address - Street 1:14402 E SPRAGUE AVE STE 16
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-2167
Practice Address - Country:US
Practice Address - Phone:509-922-2645
Practice Address - Fax:509-922-4001
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00044610207Q00000X, 2083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8455776Medicaid
WA1006214Medicaid
ID807492600Medicaid
WAG8861320Medicare PIN
WAI30030Medicare UPIN
WA8455776Medicaid
WAG8875904Medicare PIN