Provider Demographics
NPI:1619472834
Name:BROOKS, ROBERT DAVID (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DAVID
Last Name:BROOKS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6410 BREEZE ST
Mailing Address - Street 2:
Mailing Address - City:WINNECONNE
Mailing Address - State:WI
Mailing Address - Zip Code:54986-9220
Mailing Address - Country:US
Mailing Address - Phone:920-284-7333
Mailing Address - Fax:
Practice Address - Street 1:191 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:WI
Practice Address - Zip Code:54923-1241
Practice Address - Country:US
Practice Address - Phone:920-361-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-28
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI81124-21207X00000X
390200000X
WI81124207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program