Provider Demographics
NPI:1801894761
Name:BROOKS, CHARLES ATHAN (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ATHAN
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:PO BOX 1008
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78667-1008
Mailing Address - Country:US
Mailing Address - Phone:830-629-4200
Mailing Address - Fax:830-629-4206
Practice Address - Street 1:1195 GARNER FIELD RD
Practice Address - Street 2:BLDG A, SUITE 100
Practice Address - City:UVALDE
Practice Address - State:TX
Practice Address - Zip Code:78801
Practice Address - Country:US
Practice Address - Phone:830-278-6200
Practice Address - Fax:830-278-6202
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME594892085R0001X
TXR55192085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL371701100Medicaid
TX2876633-01Medicaid
TX631214ZM4MOtherMEDICARE