Provider Demographics
NPI:1184811796
Name:ANDREW F BROOKER M.D.
Entity type:Organization
Organization Name:ANDREW F BROOKER M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-468-0313
Mailing Address - Street 1:4514 CORNELL ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-5800
Mailing Address - Country:US
Mailing Address - Phone:806-355-6552
Mailing Address - Fax:806-468-0340
Practice Address - Street 1:4514 CORNELL ST
Practice Address - Street 2:SUITE B
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-5800
Practice Address - Country:US
Practice Address - Phone:806-355-6552
Practice Address - Fax:806-468-0340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5961207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMW1786Medicaid
TX142946601Medicaid
TXCK2090OtherMEDICARE RAILROAD
TX00942NOtherBLUE CROSS BLUE SHIELD
TX4557060001Medicare NSC
TX142946601Medicaid
TXD01343Medicare UPIN