Provider Demographics
NPI:1114017126
Name:BROOKS, ROGER H (AP)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:H
Last Name:BROOKS
Suffix:
Gender:M
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22606 MERIDIANA DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-6328
Mailing Address - Country:US
Mailing Address - Phone:561-750-8620
Mailing Address - Fax:561-750-6502
Practice Address - Street 1:3200 N FEDERAL HWY STE 107
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6048
Practice Address - Country:US
Practice Address - Phone:561-750-8620
Practice Address - Fax:561-750-6502
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP307171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAP307OtherLICENSE