Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 25262 | NE |
NPI | 1134178817 |
---|---|
Provider Name | Gregory D Brooks |
First Address | Bellevue, NE 68123-4303 |
Second Address | Bellevue, NE 68123-4303 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2006 |
Last Update Date | 25/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
47059317213 | (05) | NE |
H03337 | (02) |