Healthcare Provider Details

I. General information

NPI: 1477541548
Provider Name (Legal Business Name): WILLIAM R BROOKE MEDICAL DOCTOR
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 ROBERT K WILSON DR
CARROLLTON AL
35447-8010
US

IV. Provider business mailing address

241 ROBERT K WILSON DR
CARROLLTON AL
35447-8010
US

V. Phone/Fax

Practice location:
  • Phone: 205-367-2408
  • Fax: 205-367-9123
Mailing address:
  • Phone: 205-367-2408
  • Fax: 205-367-9123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number00009384
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: