Provider Demographics
NPI:1649239476
Name:INFECTIOUS DISEASE SPECIALISTS PC
Entity Type:Organization
Organization Name:INFECTIOUS DISEASE SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:804-285-1833
Mailing Address - Street 1:PO BOX 11768
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-0168
Mailing Address - Country:US
Mailing Address - Phone:804-672-4835
Mailing Address - Fax:804-213-9783
Practice Address - Street 1:7605 FOREST AVE
Practice Address - Street 2:SUITE 410
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-4938
Practice Address - Country:US
Practice Address - Phone:804-285-1833
Practice Address - Fax:804-285-5754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C06304OtherGROUP MEDICARE NUMBER