Provider Demographics
NPI:1306028535
Name:BROOKS, LANCE ROBERT
Entity Type:Individual
Prefix:MR
First Name:LANCE
Middle Name:ROBERT
Last Name:BROOKS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3130 LAMAR AVE
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-5020
Mailing Address - Country:US
Mailing Address - Phone:903-737-8800
Mailing Address - Fax:903-784-8429
Practice Address - Street 1:3130 LAMAR AVE
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-5020
Practice Address - Country:US
Practice Address - Phone:903-737-8800
Practice Address - Fax:903-784-8429
Is Sole Proprietor?:No
Enumeration Date:2007-11-29
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80263237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX198911302Medicaid
TX198911301Medicaid
TX198911304Medicaid
TX198911303Medicaid
TX198911305Medicaid