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General NPI Number Information
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NPI Number | 1790861052
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Entity Type | Individual
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Provider Name | DAVID WAYNE BROOKS M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/30/2006
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Last Update Date | 11/19/2012
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Provider Practice Location Address
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Address Line | 1933 E BRENT LN
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-3154
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Country | US
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Telephone | 479-442-4614
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Fax | 479-442-2707
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Provider Business Mailing Address
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Address Line | 1933 E BRENT LN
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-3154
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Country | US
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Telephone | 479-442-4614
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Fax | 479-442-2707
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | C7666
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License Number State | AR
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