Healthcare Provider Details

I. General information

NPI: 1275034449
Provider Name (Legal Business Name): ROBERT MIDTHUN BROOKS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2018
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1144 PROFESSIONAL DR
WILLIAMSBURG VA
23185-3330
US

IV. Provider business mailing address

PO BOX 603725
CHARLOTTE NC
28260-3725
US

V. Phone/Fax

Practice location:
  • Phone: 757-259-0443
  • Fax: 757-259-0450
Mailing address:
  • Phone: 828-575-2625
  • Fax: 828-350-2174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number0101267711
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: