Provider Demographics
NPI:1962440099
Name:BROOKS, WILLIAM JAMES (DO)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JAMES
Last Name:BROOKS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5281 N VIA SEMPREVERDE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85750-5968
Mailing Address - Country:US
Mailing Address - Phone:816-746-0128
Mailing Address - Fax:877-794-8283
Practice Address - Street 1:5281 N VIA SEMPREVERDE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85750-5968
Practice Address - Country:US
Practice Address - Phone:816-746-0128
Practice Address - Fax:877-794-8238
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2022-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO111911204D00000X
IN02000898A204D00000X
AZ1780204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO23754030OtherBCBS
MO0009691Medicare ID - Type Unspecified
MOC46866Medicare UPIN
MOC46866Medicare UPIN