Brooke, Cornelius Paul

Brooke, Cornelius Paul is an sole proprietor health care provider with primary practice located at 2001 S Woodruff Ave Ste 12A, Idaho Falls ID 83404-6374. He recently has only one registered license in Allopathic & Osteopathic Physicians / Dermatology, which is considered as his primary health care specialty. Brooke, Cornelius Paul can be contacted via phone (208) 522-8945.

Contact Information

Primary practice address
2001 S Woodruff Ave Ste 12A Idaho Falls ID 83404-6374
Phone: (208) 522-8945
Fax: (208) 522-5374
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Dermatology 207N00000X 5809M Idaho

Profile Details

NPI number 1275504300
LBN Legal business name Brooke, Cornelius Paul
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jan 27th, 2006
Last updated Jul 5th, 2016 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1275504300 NPPES
Idaho MEDICAID 002685200
Idaho Other 77186
Idaho Other 58099

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