CORNELIUS PAUL BROOKE (NPI# 1275504300) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275504300 |
| Entity Type | Individual |
| Full Name | CORNELIUS PAUL BROOKE |
| Credential | MD |
| Practice Address |
2001 S Woodruff Ave Ste 12a Idaho Falls ID 83404-6374 |
| Practice Telephone | 2085228945 |
| Practice Fax Number | 2085225374 |
| Mailing Telephone | 2085228945 |
| Mailing Fax Number | 2085225374 |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2016-07-05 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | 5809M | ID | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | 002685200 | 05 | |
| ID | BLUE CROSS | 77186 | 01 |
| BLUE CROSS | 58099 | 01 |
| Street Address |
2001 S WOODRUFF AVE STE 12A |
| City | IDAHO FALLS |
| State | ID |
| Zip Code | 83404-6374 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902809221 | James L. Richards | Surgery | 2001 S Woodruff Ave, Ste 3, Idaho Falls, ID 83404-6371 | 2005-05-31 |
| 1568912962 | Quest Diagnostics Clinical Laboratories Inc | Clinical Medical Laboratory | 2001 S Woodruff Ave, Suite 7, Idaho Falls, ID 83404-6374 | 2016-10-10 |
| 1780043042 | Teton Obstetrics and Gynecology Pa | Obstetrics & Gynecology | 2001 S Woodruff Ave, Suite 10, Idaho Falls, ID 83404-6374 | 2016-02-15 |
| 1730563909 | Radial First Cardiovascular Associates, LLC | Internal Medicine | 2001 S Woodruff Ave, Suite 3, Idaho Falls, ID 83404-6371 | 2015-07-16 |
| 1609263482 | Chad Steven Dahle | Spec/Tech, Cardiovascular | 2001 S Woodruff Ave, Suite 12 B, Idaho Falls, ID 83404-6374 | 2015-04-20 |
| 1225314677 | Janae Lynn Dye | Respiratory Therapist, Certified | 2001 S Woodruff Ave, Idaho Falls, ID 83404-6374 | 2011-10-31 |
| 1366747594 | Will G Stewart | Respiratory Therapist, Registered | 2001 S Woodruff Ave, Suite 12b, Idaho Falls, ID 83404-6374 | 2011-01-19 |
| 1043546260 | Ihc Health Services Inc | Internal Medicine | 2001 S Woodruff Ave, #12, Idaho Falls, ID 83404-6374 | 2009-10-22 |
| 1609008614 | Blake A. Stragier | Technician, Cardiology | 2001 S Woodruff Ave, Suite 12 B, Idaho Falls, ID 83404-6374 | 2009-08-10 |
| 1770712762 | Brandy Skaar | Respiratory Therapist, Registered | 2001 S Woodruff Ave, Suite 12 B, Idaho Falls, ID 83404-6374 | 2009-07-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437750809 | Joshua M Murphy | Dentist | 1580 Elk Creek Dr., Idaho Falls, ID 83404 | 2020-11-03 |
| 1427618958 | Eastern Idaho Endodontics | Dentist | 3335 S. Holmes Ave, Idaho Falls, ID 83404 | 2019-06-17 |
| 1942863600 | Muhammad Arslan Khan | Student in an Organized Health Care Education/Training Program | 2860 Channing Way Suite 214, Idaho Falls, ID 83404 | 2019-04-18 |
| 1942771043 | Physician's Choice Cardiology, Pllc | Internal Medicine | 3302 Valencia, Suite 201, Idaho Falls, ID 83404 | 2018-12-16 |
| 1609358761 | Cardiac Cath Lab of Idaho Falls | Internal Medicine | 3311 Valencia Drive, Idaho Falls, ID 83404 | 2018-09-05 |
| 1083196380 | Hannah Golden | Occupational Therapist | 1460 Elk Creek, Idaho Falls, ID 83404 | 2018-09-04 |
| 1316423049 | Lindsay Sessions | Speech-Language Pathologist | 2210 Niagara St, Idaho Falls, ID 83404 | 2018-07-16 |
| 1720574023 | Bmh, Inc. | Anesthesiology | 3302 Valencia Dr., Suite 201, Idaho Falls, ID 83404 | 2018-07-10 |
| 1093237935 | Jason Earl Bailey | Contractor | 3100 S Woodruff Ave., Idaho Falls, ID 83404 | 2017-07-12 |
| 1235682121 | Mountain Falls Quick Care | Clinic/Center | 1995 E 17th St #1, Idaho Falls, ID 83404 | 2016-07-27 |
| Find all providers in zip 83404 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437210994 | Mark E Hinkson Dermatology Pa | Dermatology | 3425 Merlin Dr Ste 200, Idaho Falls, ID 83404-7430 | 2006-12-12 |
| 1538257431 | Mark E Hinkson | Dermatology | 3425 Merlin Dr, Ste 200, Idaho Falls, ID 83404-7430 | 2006-10-10 |
| 1346432226 | Lindsay D. Sewell | Dermatology | 2085 Providence Way, Idaho Falls, ID 83404-4945 | 2007-08-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356942437 | Stoddard & Bingham Medical of Rexburg Pllc | Dermatology | 859 S Yellowstone Hwy Ste 3302, Rexburg, ID 83440-6200 | 2020-11-04 |
| 1508345091 | Integrated Dermatology of Idaho LLC | Dermatology | 388 E Parkcenter Blvd, Boise, ID 83706-3942 | 2018-08-07 |
| 1306209556 | Garrett Coman | Dermatology | St. Luke's Dermatology, 191 5th Street West, Ketchum, ID 83340 | 2016-04-04 |
| 1184080210 | Gabriel Guerrero | Dermatology | 323 E Riverside Dr Ste 234, Eagle, ID 83616 | 2016-01-05 |
| 1104220797 | Boise Skin Clinic Pllc | Dermatology | 1636 S Hadley Ave, Boise, ID 83709-2684 | 2014-10-10 |
| 1164834073 | Colby Bingham | Dermatology | 1344 Hiland Ave Ste D, Burley, ID 83318-1564 | 2014-05-27 |
| 1699194530 | Dustin Larsen | Dermatology | 2199 N Merrit Crk Loop, Coeur D Alene, ID 83814-4949 | 2014-04-08 |
| 1265795660 | Richard Scott Thomas | Dermatology | 4664 N Penngrove Way Ste 100, Meridian, ID 83646-7442 | 2012-06-20 |
| 1316216369 | Ashley Anne Hamstra | Dermatology | 421 E Lakeside Ave Ste 105, Coeur D Alene, ID 83814-2848 | 2011-12-20 |
| 1487899365 | Jaclyn Golus Mentzer | Dermatology | 388 E. Parkcenter Blvd. Gem State Dermatology, Boise, ID 83706 | 2008-12-08 |
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| City | IDAHO FALLS |
| Zip Code | 83404 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.