Provider Demographics
NPI:1376765511
Name:BROOKS, BARNEY LEE
Entity Type:Individual
Prefix:MR
First Name:BARNEY
Middle Name:LEE
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 1:1800 INDIANA AVE.
Mailing Address - Street 2:
Mailing Address - City:LAPORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-6210
Mailing Address - Country:US
Mailing Address - Phone:574-286-4823
Mailing Address - Fax:269-926-4045
Practice Address - Street 1:1800 INDIANA AVE.
Practice Address - Street 2:
Practice Address - City:LAPORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-5210
Practice Address - Country:US
Practice Address - Phone:574-286-4823
Practice Address - Fax:269-926-4045
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN171WH0202X171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications