Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 01030932A | IN |
Y | 208600000X | Surgeon | 01030932A | IN |
NPI | 1023086014 |
---|---|
Provider Name | Larry E Brooks |
First Address | North Vernon, IN 47265-0358 |
Second Address | North Vernon, IN 47265 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2006 |
Last Update Date | 10/04/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100140500 | (05) | IN |
C24905 | (02) | |
DC3600 | RAILROAD GROUP (01) | IN |
P00471276 | RAILROAD INDIVIDUAL (01) | IN |