Provider Demographics
NPI:1699003129
Name:BROOKS, DOMINIQUE WALTON (MD)
Entity Type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:WALTON
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6065 HILLCROFT ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-1087
Mailing Address - Country:US
Mailing Address - Phone:713-772-3200
Mailing Address - Fax:
Practice Address - Street 1:6065 HILLCROFT ST
Practice Address - Street 2:SUITE 109
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-1087
Practice Address - Country:US
Practice Address - Phone:713-772-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-20
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0021207W00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology