HERBERT E BROOKS MD PA
Medical Practice at Highway 173, Caryville, FL

License number
Florida ME11075
Category
Medical Practice
Type
Legal Medicine
Owner
Name: HERBERT EDWIN BROOKS MD
Title: OWNER
Phone: (850) 547-4793
Address
Address
2126 Highway 173, Caryville, FL 32425
National Provider ID: 1598091100
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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HERBERT E. BROOKS, M.D., PA

Caryville, FL

Status:
Inactive
Industry:
Medical Doctor's Office, Nonclassifiable Establishments
Inactive reason:
Admin Dissolution For Annual Report
Registration:
Sep 1, 1980
Inactive since:
Sep 28, 2012
Addresses:
2126 Hwy 173, Bonifay, FL 32425 (Physical)
Bonifay, FL 32425 (Mailing)
310 E Byrd Ave, Caryville, FL 32425
310 Byrd Ave, Caryville, FL 32425
PO Box 699, Caryville, FL 32425
State ID:
681945
Business type:
Florida Profit Corporation
President, Treasurer, Director, Secretary:
Herbert E. Brooks President, Treasurer, Director, Secretary, inactive, 2126 Hwy 173, Bonifay, FL 32425 (Physical)
Agent:
Herbert Brooks,2126 Hwy 173, Bonifay, FL 32425 (Physical)
EIN:
59-2021817

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