Healthcare Provider Details

I. General information

NPI: 1073540795
Provider Name (Legal Business Name): PAUL V. BROOKS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 04/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

976 N MAIN ST
NICHOLASVILLE KY
40356-2308
US

IV. Provider business mailing address

PO BOX 911148
LEXINGTON KY
40591-1148
US

V. Phone/Fax

Practice location:
  • Phone: 859-887-2994
  • Fax: 859-885-9918
Mailing address:
  • Phone: 859-278-2121
  • Fax: 859-276-1649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number32337
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: