Healthcare Provider Details

I. General information

NPI: 1659515708
Provider Name (Legal Business Name): WILLIAM E BROOKS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2009
Last Update Date: 08/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 NEALY AVENUE 633D MEDICAL GROUP
JOINT BASE LANGLEY-EUSTIS VA
23665-2040
US

IV. Provider business mailing address

77 NEALY AVENUE 633D MEDICAL GROUP
JOINT BASE LANGLEY-EUSTIS VA
23665-2040
US

V. Phone/Fax

Practice location:
  • Phone: 757-764-6800
  • Fax:
Mailing address:
  • Phone: 757-764-6800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101249439
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: