Provider Demographics
NPI:1689360885
Name:FITCH, BROOKE EDEN (DO)
Entity Type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:EDEN
Last Name:FITCH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:EDEN
Other - Last Name:MCMINN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8365 EMERALD CIR
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-5778
Mailing Address - Country:US
Mailing Address - Phone:903-880-3623
Mailing Address - Fax:
Practice Address - Street 1:700 E MARSHALL AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5580
Practice Address - Country:US
Practice Address - Phone:903-315-1696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10083694390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program