Provider Demographics
NPI:1407968894
Name:BROOKS, KATHLEEN LAWLOR (MD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:LAWLOR
Last Name:BROOKS
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 1:413 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AZLE
Mailing Address - State:TX
Mailing Address - Zip Code:76020-2905
Mailing Address - Country:US
Mailing Address - Phone:817-444-9001
Mailing Address - Fax:817-444-9958
Practice Address - Street 1:413 W MAIN ST
Practice Address - Street 2:
Practice Address - City:AZLE
Practice Address - State:TX
Practice Address - Zip Code:76020-2905
Practice Address - Country:US
Practice Address - Phone:817-444-9001
Practice Address - Fax:817-444-9958
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA141700207Q00000X
AZ51654207Q00000X
MN60689207Q00000X
ORMD175681207Q00000X
MS24520207Q00000X
LA303427207Q00000X
ALMD.35205207Q00000X
IL036141129207Q00000X
WAMD60621771207Q00000X
CODR.0057708207Q00000X
TXJ6350207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122109504Medicaid
TX0017AAMedicare ID - Type Unspecified
F85428Medicare UPIN