Healthcare Provider Details

I. General information

NPI: 1932134889
Provider Name (Legal Business Name): ROGER A BROOKSBANK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 04/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 ALCOA HWY
KNOXVILLE TN
37920-1511
US

IV. Provider business mailing address

PO BOX 634706
CINCINNATI OH
45263-0001
US

V. Phone/Fax

Practice location:
  • Phone: 865-544-9000
  • Fax: 865-539-8008
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number019705
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: