Healthcare Provider Details

I. General information

NPI: 1992706170
Provider Name (Legal Business Name): FLEMING G. BROOKS JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 11/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 N MAIN ST
ENTERPRISE AL
36330-2563
US

IV. Provider business mailing address

PO BOX 729
DOTHAN AL
36302-0729
US

V. Phone/Fax

Practice location:
  • Phone: 334-308-9797
  • Fax: 334-308-2909
Mailing address:
  • Phone: 334-793-2663
  • Fax: 334-836-2247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number21113
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: