Healthcare Provider Details

I. General information

NPI: 1184919573
Provider Name (Legal Business Name): TIMOTHY RAY BROOKS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2011
Last Update Date: 10/12/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 ADMIRAL TAUSSIG BLVD
NORFOLK VA
23511-2802
US

IV. Provider business mailing address

USS KEARSARGE (LHD 3)
FPO AE
09534
US

V. Phone/Fax

Practice location:
  • Phone: 757-953-9000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101252343
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101252343
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: