Provider Demographics
NPI:1700928082
Name:BROOKS, JAMES R I (MD)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:R
Last Name:BROOKS
Suffix:I
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:75-5591 PALANI RD 3002
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-3633
Mailing Address - Country:US
Mailing Address - Phone:808-769-5010
Mailing Address - Fax:808-769-5208
Practice Address - Street 1:140 S. 77TH ST.
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114
Practice Address - Country:US
Practice Address - Phone:402-934-4535
Practice Address - Fax:402-934-5939
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2018-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE223042083X0100X
HI16362208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NES57475Medicare UPIN
S57475Medicare UPIN