Provider Demographics
NPI:1639174170
Name:BROOKS, STEWART T (PA)
Entity Type:Individual
Prefix:
First Name:STEWART
Middle Name:T
Last Name:BROOKS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8441 STATE HIGHWAY 47 STE 4300
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77807-3235
Mailing Address - Country:US
Mailing Address - Phone:979-776-8896
Mailing Address - Fax:
Practice Address - Street 1:8441 STATE HIGHWAY 47 STE 4300
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77807-3235
Practice Address - Country:US
Practice Address - Phone:979-776-8896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004055363AS0400X
TXPA06723363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0211459OtherL&I NUMBER
WA0211459OtherL&I NUMBER