Provider Demographics
NPI:1326091570
Name:BROOKS, GREGORY NORMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:NORMAN
Last Name:BROOKS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8020 CONSTITUTION PL NE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-7607
Mailing Address - Country:US
Mailing Address - Phone:505-998-3096
Mailing Address - Fax:505-998-3100
Practice Address - Street 1:8020 CONSTITUTION PL NE
Practice Address - Street 2:SUITE 202
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-7607
Practice Address - Country:US
Practice Address - Phone:505-998-3096
Practice Address - Fax:505-998-3100
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMMD2010-00932085R0204X, 2085R0202X, 2085R0202X
WI400842085R0202X
NE248872085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC048769Medicaid
NC048769Medicaid
H64250Medicare UPIN
AZ108809Medicare PIN
BB7864792OtherDEA
NC048769Medicaid