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General NPI Number Information
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NPI Number | 1952694234
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Entity Type | Organization
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Legal Business Name | JACK G BROOKS MD PA
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Dates
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Enumeration Date | 05/19/2011
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Last Update Date | 06/01/2011
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Provider Practice Location Address
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Address Line | 2726 COUNTRY CLUB RD
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City | ARLINGTON
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State | TX
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Zip | 76013-3100
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Country | US
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Telephone | 817-274-7373
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Fax | 817-274-1176
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Provider Business Mailing Address
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Address Line | 2726 COUNTRY CLUB RD
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City | ARLINGTON
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State | TX
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Zip | 76013-3100
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Country | US
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Telephone |
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Fax | 817-274-1176
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Authorized Official
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Title or Position | RADIOLOGIST
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Name | DR. JACK G BROOKS
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Credential | M.D.
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Telephone | 817-274-7373
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number | D2754
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License Number State | TX
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