Provider Demographics
NPI:1093822918
Name:BROOKS, WILLIAM BOGAN III (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BOGAN
Last Name:BROOKS
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5750 A SOUTHLAND DRIVE
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36693-3316
Mailing Address - Country:US
Mailing Address - Phone:251-450-2211
Mailing Address - Fax:251-662-7297
Practice Address - Street 1:1015 MONTLIMAR DR
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-1713
Practice Address - Country:US
Practice Address - Phone:251-450-2211
Practice Address - Fax:251-662-7297
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME0122342084P0800X
RIMD131642084P0800X
AL302312084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL102I266400Medicare UPIN
MEMM0705Medicare ID - Type Unspecified