Provider Demographics
NPI:1700525664
Name:ANDERSON, BROOKLYN LEE (MD)
Entity Type:Individual
Prefix:
First Name:BROOKLYN
Middle Name:LEE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:7703 FLOYD CURL DR # MC7795
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3901
Mailing Address - Country:US
Mailing Address - Phone:210-358-3888
Mailing Address - Fax:
Practice Address - Street 1:7703 FLOYD CURL DR # MC7795
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3901
Practice Address - Country:US
Practice Address - Phone:210-358-3931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXBP10078445207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX744204OtherTEXAS MEDICAL BOARD PHYSICIAN IN TRAINING