Provider Demographics
NPI:1902858707
Name:BROOKS, DOUGLAS PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:PAUL
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 1:1512 36TH ST
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26104-1942
Mailing Address - Country:US
Mailing Address - Phone:304-893-9251
Mailing Address - Fax:304-893-9152
Practice Address - Street 1:1512 36TH ST
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26104-1942
Practice Address - Country:US
Practice Address - Phone:304-893-9251
Practice Address - Fax:304-893-9152
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006-01808207Q00000X
WV27640207Q00000X
FLME80363207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC232009OtherMEDICARE PTAN, GROUP
NC2063252WOtherMEDICARE PTAN, INDIVIDUAL
FL080160825OtherRAILROAD MEDICARE NUMBER
NC232009OtherMEDICARE PTAN, GROUP
FL260191500Medicaid
NC2063252RMedicare PIN
NC2063252TMedicare PIN
NC232009OtherMEDICARE PTAN, GROUP
NC2063252QMedicare PIN
NC2063252MMedicare PIN
NC2063252DMedicare PIN
NC2063252SMedicare PIN
NC2063252KMedicare PIN
NC2063252GMedicare PIN
NC2063252EMedicare PIN
FL080160825OtherRAILROAD MEDICARE NUMBER
NC2063252PMedicare PIN
NC2063252VMedicare PIN
NC2063252Medicare PIN
FL51568ZMedicare ID - Type Unspecified
NC2063252NMedicare PIN
NC2063252JMedicare PIN