Basic Information
| Provider Information | |||||||||
| NPI: | 1326096231 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DANIEL | ||||||||
| FirstName: | BROOKE | ||||||||
| MiddleName: | E. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 605 GLENWOOD DRIVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374041130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4236981844 | ||||||||
| FaxNumber: | 4236242226 | ||||||||
| Practice Location | |||||||||
| Address1: | 605 GLENWOOD DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374041108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4236981844 | ||||||||
| FaxNumber: | 4236242226 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | MD39893 | TN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RH0003X | 056540 | GA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 332038 | 05 | TN | MEDICAID | 287230833A | 05 | TN | MEDICAID |