Provider Demographics
NPI:1639196223
Name:BROOKS, MICHAEL E (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:E
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:PO BOX 12630
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-8630
Mailing Address - Country:US
Mailing Address - Phone:817-870-0172
Mailing Address - Fax:817-870-0158
Practice Address - Street 1:2260 COLLEGE AVENUE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110-1952
Practice Address - Country:US
Practice Address - Phone:817-870-0172
Practice Address - Fax:817-870-0158
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7704208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX020054285OtherRAILROAD MEDICARE
TX098240703Medicaid