Provider Demographics
NPI:1134178817
Name:BROOKS, GREGORY D (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:D
Last Name:BROOKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3503 SAMSON WAY
Mailing Address - Street 2:SUITE 108
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-4303
Mailing Address - Country:US
Mailing Address - Phone:402-592-2055
Mailing Address - Fax:402-592-2419
Practice Address - Street 1:3503 SAMSON WAY
Practice Address - Street 2:SUITE 108
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123-4303
Practice Address - Country:US
Practice Address - Phone:402-592-2055
Practice Address - Fax:402-592-2419
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE25262207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47059317213Medicaid
NE1134178817Medicare PIN
H03337Medicare UPIN