Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 4301088759 | MI |
Y | 207X00000X | Orthopaedic Surgeon | N3515 | TX |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | N3515 | TX |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 4301088759 | MI |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | N3515 | TX |
NPI | 1093930562 |
---|---|
Provider Name | Dr. Kenneth Ryan Brooks |
First Address | Houston, TX 77058-3683 |
Second Address | Houston, TX 77058-3683 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2007 |
Last Update Date | 09/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
206898301 | (05) | TX |
206898304 | (05) | TX |
5209565 | (05) | MI |
8FU628 | BLUE CROSS BLUE SHIELD (01) | TX |