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General NPI Number Information
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NPI Number | 1053374876
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Entity Type | Organization
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Legal Business Name | BROOKS ALLISON, MD PC
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Dates
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Enumeration Date | 04/11/2006
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Last Update Date | 07/19/2007
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Provider Practice Location Address
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Address Line | 2100 W SUNSET DR
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City | RIVERTON
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State | WY
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Zip | 82501-2274
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Country | US
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Telephone | 307-857-3590
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Fax | 307-857-3553
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Provider Business Mailing Address
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Address Line | 2100 W SUNSET DR
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City | RIVERTON
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State | WY
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Zip | 82501-2274
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Country | US
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Telephone | 307-857-3590
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Fax | 307-857-3553
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Authorized Official
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Title or Position | CEO
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Name | ARCHIE BROOKS ALLISON
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Credential | MD
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Telephone | 307-857-3590
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 4404A
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License Number State | WY
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