Basic Information
| Provider Information | |||||||||
| NPI: | 1245424365 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BROOK | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | DAVID | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3303 | ||||||||
| Address2: | |||||||||
| City: | PALM SPRINGS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922633303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7604164721 | ||||||||
| FaxNumber: | 7604164875 | ||||||||
| Practice Location | |||||||||
| Address1: | 1180 N INDIAN CANYON DR | ||||||||
| Address2: | SUIT E-218 | ||||||||
| City: | PALM SPRINGS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922624800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7604164721 | ||||||||
| FaxNumber: | 7604164875 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2007 | ||||||||
| LastUpdateDate: | 08/11/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | A116376 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | A116376 | 01 | CA | MEDICAL LICENSE | OTHER |