Healthcare Provider Details

I. General information

NPI: 1750400636
Provider Name (Legal Business Name): LOUISE MARIE BROOKER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4514 CORNELL ST SUITE B
AMARILLO TX
79109-5800
US

IV. Provider business mailing address

4514 CORNELL ST SUITE B
AMARILLO TX
79109-5800
US

V. Phone/Fax

Practice location:
  • Phone: 806-355-6552
  • Fax: 806-468-0340
Mailing address:
  • Phone: 806-355-6552
  • Fax: 806-468-0340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberPA00898
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: