Healthcare Provider Details

I. General information

NPI: 1104836543
Provider Name (Legal Business Name): MICHAEL POLLARD BROOKS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 S 11TH AVE
LAUREL MS
39440-4313
US

IV. Provider business mailing address

128 S 11TH AVE
LAUREL MS
39440-4313
US

V. Phone/Fax

Practice location:
  • Phone: 601-649-8732
  • Fax: 601-649-5051
Mailing address:
  • Phone: 601-649-8732
  • Fax: 601-649-5051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number06389
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: