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NPI Code Detail

MEDICARE: BROOKS BARHAM M.D.

MEDICARE: BROOKS BARHAM M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology Physician17522MS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1336155399
Entity Type Code : Individual
Provider Name (Legal Business Name) : BROOKS BARHAM M.D.
Provider Business Mailing Address
First Line : PO BOX 4710
Second Line :
City : JACKSON
State : MS
Zip : 39296-4710
Country : US
Telephone Number : 601-936-0494
Fax Number :
Provider Business Practice Location Address
First Line : 1030 RIVER OAKS DR
Second Line :
City : JACKSON
State : MS
Zip : 39232-9553
Country : US
Telephone Number : 601-936-0494
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2006
Last Update Date : 04/14/2009

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