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General NPI Number Information
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NPI Number | 1073663688
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Entity Type | Individual
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Provider Name | BROOKS ROSS GREGER II CRNA
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Gender | Male
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 08/18/2023
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Provider Practice Location Address
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Address Line | 419 W 5TH ST
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City | ODESSA
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State | TX
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Zip | 79761-5026
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Country | US
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Telephone | 432-640-2401
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Fax |
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Provider Business Mailing Address
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Address Line | 6313 PRAIRIE RIDGE DR
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City | MIDLAND
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State | TX
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Zip | 79707-5067
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Country | US
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Telephone | 469-383-9991
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 688504
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License Number State | TX
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