Healthcare Provider Details

I. General information

NPI: 1659341105
Provider Name (Legal Business Name): KEVIN EUGENE BROOKS M.D. M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 01/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 TOMCAT BLVD STE 150 BRANCH HEALTH CLINIC OCEANA
VIRGINIA BEACH VA
23460-2186
US

IV. Provider business mailing address

1305 MANNING RD
SUFFOLK VA
23434-8575
US

V. Phone/Fax

Practice location:
  • Phone: 757-953-3835
  • Fax: 757-953-3763
Mailing address:
  • Phone: 757-539-0446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License NumberR1G1O
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: