Healthcare Provider Details

I. General information

NPI: 1760797401
Provider Name (Legal Business Name): BROOKS MED GROUP CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2010
Last Update Date: 10/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2840 S 70TH ST SUITE 7-368
LINCOLN NE
68506-3662
US

IV. Provider business mailing address

2840 S 70TH ST SUITE 7-368
LINCOLN NE
68506-3662
US

V. Phone/Fax

Practice location:
  • Phone: 402-878-0059
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number25262
License Number StateNE

VIII. Authorized Official

Name: GREGORY BROOKS
Title or Position: CEO
Credential:
Phone: 402-878-0059