Provider Demographics
NPI:1376559641
Name:BROOKE, DAWN S (MD)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:S
Last Name:BROOKE
Suffix:
Gender:F
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 26726
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78755-0726
Mailing Address - Country:US
Mailing Address - Phone:512-407-8686
Mailing Address - Fax:512-421-4489
Practice Address - Street 1:10401 ANDERSON MILL #110B
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-2579
Practice Address - Country:US
Practice Address - Phone:512-250-5571
Practice Address - Fax:512-335-3068
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6073208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX136237801Medicaid
TX136237812Medicaid
TX136237810Medicaid
TX136237811Medicaid
TX136237812Medicaid
TXTXB121134Medicare PIN
TX82516KMedicare PIN
TX136237811Medicaid
TXTXB121133Medicare PIN