Provider Demographics
NPI:1982838488
Name:BROOKS, ROBERT TERYL JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:TERYL
Last Name:BROOKS
Suffix:JR
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 1:4611 STEVENS DR
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-7303
Mailing Address - Country:US
Mailing Address - Phone:870-536-3266
Mailing Address - Fax:
Practice Address - Street 1:4611 STEVENS DR
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-7303
Practice Address - Country:US
Practice Address - Phone:870-536-3266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR-1880208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology