Provider Demographics
NPI:1508926064
Name:BROOKS, ALLEN G (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:G
Last Name:BROOKS
Suffix:
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 1:1086 7TH AVE SW
Mailing Address - Street 2:#202
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-1997
Mailing Address - Country:US
Mailing Address - Phone:541-928-2965
Mailing Address - Fax:541-917-3778
Practice Address - Street 1:1086 7TH AVE SW
Practice Address - Street 2:#202
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-1997
Practice Address - Country:US
Practice Address - Phone:541-928-2965
Practice Address - Fax:541-917-3778
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13082MD2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR257238Medicaid
ORR0000BHSBSMedicare ID - Type Unspecified
OR257238Medicaid