Provider Demographics
NPI:1437550613
Name:RALPH A BROOKS, M.D. LLC
Entity Type:Organization
Organization Name:RALPH A BROOKS, M.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-521-3698
Mailing Address - Street 1:PO BOX 1905
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76101-1905
Mailing Address - Country:US
Mailing Address - Phone:817-521-3698
Mailing Address - Fax:
Practice Address - Street 1:6116 OAKBEND TRL
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-3925
Practice Address - Country:US
Practice Address - Phone:817-521-3698
Practice Address - Fax:817-346-7408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-08
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3656207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty