Provider Demographics
NPI:1134196546
Name:BROOKS, LLOYD W (DO)
Entity type:Individual
Prefix:
First Name:LLOYD
Middle Name:W
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 1:9229 LYNDON B JOHNSON FWY
Mailing Address - Street 2:SUITE 250
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-3405
Mailing Address - Country:US
Mailing Address - Phone:972-739-3097
Mailing Address - Fax:972-739-2673
Practice Address - Street 1:1201 SUMMIT AVE STE 500
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-4428
Practice Address - Country:US
Practice Address - Phone:817-332-9494
Practice Address - Fax:817-870-1474
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0213207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4033240502Medicaid
TX4033240502Medicaid
TX8293K4Medicare ID - Type Unspecified
TX8G6347Medicare ID - Type Unspecified
TXB21521Medicare UPIN
TX8J1000Medicare ID - Type Unspecified