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General NPI Number Information
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NPI Number | 1639174170
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Entity Type | Individual
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Provider Name | STEWART T BROOKS PA
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Gender | Male
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Dates
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Enumeration Date | 06/20/2005
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Last Update Date | 08/12/2015
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Provider Practice Location Address
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Address Line | 8441 STATE HIGHWAY 47 STE 4300
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City | BRYAN
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State | TX
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Zip | 77807-3235
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Country | US
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Telephone | 979-776-8896
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Fax |
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Provider Business Mailing Address
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Address Line | 8441 STATE HIGHWAY 47 STE 4300
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City | BRYAN
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State | TX
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Zip | 77807-3235
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Country | US
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Telephone | 979-776-8896
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA10004055
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA06723
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License Number State | TX
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