Provider Demographics
NPI:1780764472
Name:BROOKS, LAWRENCE ROBYN (MD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:ROBYN
Last Name:BROOKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1245 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 407
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017
Mailing Address - Country:US
Mailing Address - Phone:213-977-4979
Mailing Address - Fax:213-977-0544
Practice Address - Street 1:1245 WILSHIRE BLVD
Practice Address - Street 2:SUITE 407
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017
Practice Address - Country:US
Practice Address - Phone:213-977-4979
Practice Address - Fax:213-977-0544
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG57144207R00000X, 207RP1001X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G571440Medicaid
CAWG57144Medicare ID - Type Unspecified
CA00G571440Medicaid