Provider Demographics
NPI:1912978321
Name:BROOKS, CLYDE M (DO)
Entity Type:Individual
Prefix:
First Name:CLYDE
Middle Name:M
Last Name:BROOKS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1037 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-2307
Mailing Address - Country:US
Mailing Address - Phone:304-523-0266
Mailing Address - Fax:304-523-0255
Practice Address - Street 1:1037 6TH AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-2307
Practice Address - Country:US
Practice Address - Phone:304-523-0266
Practice Address - Fax:304-523-0255
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.007823207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine