Provider Demographics
NPI:1013082585
Name:BROOKS, ALBERT DENNIS (MD)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:DENNIS
Last Name:BROOKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:A
Other - Middle Name:DENNIS
Other - Last Name:BROOKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:7605 NATURAL BRIDGE RD
Mailing Address - Street 2:STE 101
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63121-4922
Mailing Address - Country:US
Mailing Address - Phone:314-261-4844
Mailing Address - Fax:314-261-2630
Practice Address - Street 1:7601 NATURAL BRIDGE RD
Practice Address - Street 2:STE 102
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63121-4904
Practice Address - Country:US
Practice Address - Phone:314-261-4844
Practice Address - Fax:314-261-2630
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5E25207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOR5E25OtherSTATE MEDICAL LICENSE
MO202260600Medicaid
MOR5E25OtherSTATE MEDICAL LICENSE
MO202260600Medicaid