Provider Demographics
NPI:1730311267
Name:BROOKS, RONALD EDWARD (CPO)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:EDWARD
Last Name:BROOKS
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 MILLS AVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4218
Mailing Address - Country:US
Mailing Address - Phone:864-282-5213
Mailing Address - Fax:864-282-5214
Practice Address - Street 1:529 MILLS AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4218
Practice Address - Country:US
Practice Address - Phone:864-282-5213
Practice Address - Fax:864-282-5214
Is Sole Proprietor?:No
Enumeration Date:2009-08-18
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist