Provider Demographics
NPI:1225190689
Name:BROOKS, ANNE E (DO)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:E
Last Name:BROOKS
Suffix:
Gender:F
Credentials:DO
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 462
Mailing Address - Street 2:205 ALMA
Mailing Address - City:TUTWILER
Mailing Address - State:MS
Mailing Address - Zip Code:38963
Mailing Address - Country:US
Mailing Address - Phone:662-345-8334
Mailing Address - Fax:662-345-8336
Practice Address - Street 1:205 ALMA ST
Practice Address - Street 2:
Practice Address - City:TUTWILER
Practice Address - State:MS
Practice Address - Zip Code:38963
Practice Address - Country:US
Practice Address - Phone:662-345-8334
Practice Address - Fax:662-345-8336
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS10092207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00115755Medicaid
MS00115755Medicaid
MS080003789Medicare ID - Type Unspecified