Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 5216 | OK |
NPI | 1114918844 |
---|---|
Provider Name | Dr. Perry L Brooks |
First Address | Lawton, OK 73505 |
Second Address | Lawton, OK 73505 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2005 |
Last Update Date | 12/06/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U58633 | (02) | OK |