Provider Demographics
NPI:1003834599
Name:BROOKS, MARK (PA-C)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:BROOKS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1702 FM 1960 BYPASS RD E
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-3916
Mailing Address - Country:US
Mailing Address - Phone:281-446-7173
Mailing Address - Fax:832-644-5615
Practice Address - Street 1:17903 W LAKE HOUSTON PKWY STE 201
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-3954
Practice Address - Country:US
Practice Address - Phone:281-446-7173
Practice Address - Fax:832-644-5615
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03324363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G1131Medicare ID - Type Unspecified
P87757Medicare UPIN