Provider Demographics
NPI:1790984458
Name:BROOKS, JOHN HOWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HOWARD
Last Name:BROOKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6322 FAYETTEVILLE RD STE B
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-7979
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6322 FAYETTEVILLE RD
Practice Address - Street 2:SUITE B
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-7979
Practice Address - Country:US
Practice Address - Phone:910-878-6700
Practice Address - Fax:910-417-4120
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-01547207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP00963701OtherRAILROAD MEDICARE
150G7OtherBC/BS NC PROVIDER #
SCN01541OtherSC MEDICAID PROVIDER #
NC5909948Medicaid
FH2967615OtherFIRSTCAROLINACARE PROVIDER #
P00665198OtherRAILROAD MEDICARE PROV#
2022787Medicare PIN