Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0201X | Pediatric Allergist | H0212 | TX |
NPI | 1134211998 |
---|---|
Provider Name | Edward G Brooks |
First Address | Galveston, TX 77555-1022 |
Second Address | Galveston, TX 77555-1022 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2006 |
Last Update Date | 05/12/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
124714001 | (05) | TX |
F53762 | (02) | TX |