Provider Demographics
NPI:1134205271
Name:D. WAYNE BROOKS, M.D., P.A.
Entity type:Organization
Organization Name:D. WAYNE BROOKS, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-927-2221
Mailing Address - Street 1:601 W. MAPLE
Mailing Address - Street 2:SUITE 511
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-5376
Mailing Address - Country:US
Mailing Address - Phone:479-927-2221
Mailing Address - Fax:479-927-2101
Practice Address - Street 1:601 W. MAPLE
Practice Address - Street 2:SUITE 511
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-5376
Practice Address - Country:US
Practice Address - Phone:479-927-2221
Practice Address - Fax:479-927-2101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARMC1464208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5B516Medicare ID - Type Unspecified