Provider Demographics
NPI:1134290638
Name:BROOKS, ROBERT JOMAX (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOMAX
Last Name:BROOKS
Suffix:
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:PO BOX 787
Mailing Address - Street 2:
Mailing Address - City:NORTH ADAMS
Mailing Address - State:MA
Mailing Address - Zip Code:01247-0787
Mailing Address - Country:US
Mailing Address - Phone:413-663-7796
Mailing Address - Fax:413-663-9452
Practice Address - Street 1:82 ELM ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER CENTER
Practice Address - State:VT
Practice Address - Zip Code:05255-9642
Practice Address - Country:US
Practice Address - Phone:413-281-8791
Practice Address - Fax:866-686-8033
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT42-00088952084P0800X
NY90497832084P0800X
VT2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN0796Medicaid
MA3151000Medicaid
VTVN0796Medicare PIN
VTBRA20928Medicare ID - Type Unspecified
VTOVN0796Medicaid
MAA20928Medicare PIN