Provider Demographics
NPI:1346210184
Name:BROOKS, JAMES STEPHEN (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:STEPHEN
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 1:2124 GRANVILLE RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52556-8771
Mailing Address - Country:US
Mailing Address - Phone:808-353-1321
Mailing Address - Fax:641-472-4609
Practice Address - Street 1:1080 N 4TH ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IA
Practice Address - Zip Code:52556-2046
Practice Address - Country:US
Practice Address - Phone:641-472-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA229632084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0178004Medicaid
IAE28079Medicare UPIN
IA0178004Medicaid