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:
Health care specialties
| Specialty | Code | License # | 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1275504300 | NPPES |
| Idaho | MEDICAID | 002685200 | |
| Idaho | Other | 77186 | |
| Idaho | Other | 58099 |
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