Provider Demographics
NPI:1568514891
Name:BROOKS, ALBERT L (MD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:L
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 1:2000 MOWRY AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1716
Mailing Address - Country:US
Mailing Address - Phone:510-795-2026
Mailing Address - Fax:510-792-0795
Practice Address - Street 1:1860 MOWRY AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1730
Practice Address - Country:US
Practice Address - Phone:510-795-2026
Practice Address - Fax:510-792-0795
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG366000207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G366000Medicaid
CA00G366000OtherBLUE SHIELD OF CA PIN
CA00G366000Medicaid
CA00G366000OtherBLUE SHIELD OF CA PIN