Provider Demographics
NPI:1831157890
Name:BROOKS, HAROLD LOGAN JR (MD)
Entity type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:LOGAN
Last Name:BROOKS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2439 CARE DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4580
Mailing Address - Country:US
Mailing Address - Phone:850-942-6700
Mailing Address - Fax:850-942-5735
Practice Address - Street 1:2439 CARE DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4580
Practice Address - Country:US
Practice Address - Phone:850-942-6700
Practice Address - Fax:850-942-5735
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME42558207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL061841100Medicaid
GA000419746AMedicaid
GA18BBDZVMedicare ID - Type Unspecified
A99723Medicare UPIN
GA000419746AMedicaid