Individual
MR. JOHNNIE RAY BROOKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1503 OAK ST, JACKSONVILLE, FL 32204-3910
(904) 634-0640
Mailing address
7305 PURPLE AVENS AVE, UPPER MARLBORO, MD 20772-6327
(301) 599-0787
(301) 599-6808
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA 9103751
FL
Other
Enumeration date
07/26/2006
Last updated
07/08/2007
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