Provider Demographics
NPI:1427215128
Name:BROOKS, JASON ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:ANDREW
Last Name:BROOKS
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:759 45TH AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2938
Mailing Address - Country:US
Mailing Address - Phone:219-922-6226
Mailing Address - Fax:
Practice Address - Street 1:759 45TH AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2938
Practice Address - Country:US
Practice Address - Phone:219-922-6226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01065114A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN01065114AOtherMEDICAL LICENSE
IN35-1441433OtherCSHCS
IN1427215128OtherBCBS IL
IN9401139OtherAETNA
ININ5114OtherEYEMED
IN35-1441433OtherWAUSAU
IN351441433OtherCIGNA
IN570331OtherANTHEM BCBS
IN01065114BOtherCONTROLLED SUBSTANCE REGISTRATION
IN01065114BOtherCONTROLLED SUBSTANCE REGISTRATION