Provider Demographics
NPI:1467561233
Name:MONAGHAN, BROOKS V JR (MD)
Entity Type:Individual
Prefix:DR
First Name:BROOKS
Middle Name:V
Last Name:MONAGHAN
Suffix:JR
Gender:M
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 188
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:38635-0188
Mailing Address - Country:US
Mailing Address - Phone:662-252-1674
Mailing Address - Fax:662-252-5005
Practice Address - Street 1:226 BETHLEHEM ST
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:38635
Practice Address - Country:US
Practice Address - Phone:662-252-1674
Practice Address - Fax:662-252-5005
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS5135208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0014298Medicaid
MSB30443Medicare UPIN