Provider Demographics
NPI:1790297836
Name:BROOKS, RICHARD BADOR
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:BADOR
Last Name:BROOKS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:637 BROOKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-1802
Mailing Address - Country:US
Mailing Address - Phone:317-627-6440
Mailing Address - Fax:317-888-5356
Practice Address - Street 1:637 BROOKVIEW DR
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-1802
Practice Address - Country:US
Practice Address - Phone:317-627-6440
Practice Address - Fax:317-888-5356
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-30
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies