Individual
BROOKS W BOOKER IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1501 NE MEDICAL CENTER DR, BEND, OR 97701-6051
(541) 382-2811
Mailing address
PO BOX 6048, BEND, OR 97708-6048
(541) 382-2811
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD167654
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11057533
CAQH
OR
05
—
500672815
—
OR
Enumeration date
07/29/2006
Last updated
01/29/2021
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