Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 09041985 | MD |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | 25001 | MS |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | A139710 | CA |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | T2124 | TX |
NPI | 1194014258 |
---|---|
Provider Name | Dr. Jaysson Trevor Brooks |
First Address | Dallas, TX 75219-3924 |
Second Address | Dallas, TX 75219-3924 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2011 |
Last Update Date | 23/08/2021 |