Provider Demographics
NPI:1952304297
Name:BROOKER, OLMER RONNIE (MD)
Entity Type:Individual
Prefix:DR
First Name:OLMER
Middle Name:RONNIE
Last Name:BROOKER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:11880 VISTA DEL SOL DR
Mailing Address - Street 2:STE B
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-6128
Mailing Address - Country:US
Mailing Address - Phone:915-855-7900
Mailing Address - Fax:915-855-7755
Practice Address - Street 1:1418 GEORGE DIETER DR
Practice Address - Street 2:STE B
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-7601
Practice Address - Country:US
Practice Address - Phone:915-855-7900
Practice Address - Fax:915-855-7755
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2017-02-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXE5012207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123970905Medicaid
TX123970905Medicaid
TX8F1428Medicare PIN