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NPI Code Detail

MEDICARE: BROOKS SURGERY CLINIC, PLLC

MEDICARE: BROOKS SURGERY CLINIC, PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208600000XSurgery PhysicianH7704TX

General Provider Information

NPI Number : 1083045041
Entity Type Code : Organization
Provider Name (Legal Business Name) : BROOKS SURGERY CLINIC, PLLC
Provider Business Mailing Address
First Line : PO BOX 12630
Second Line :
City : FORT WORTH
State : TX
Zip : 76110-8630
Country : US
Telephone Number : 817-870-0172
Fax Number : 817-870-0158
Provider Business Practice Location Address
First Line : 2260 COLLEGE AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76110-1952
Country : US
Telephone Number : 817-870-0172
Fax Number : 817-870-0158
Authorized Official
Title or Position : OWNER
Name : DR. MICHAEL EDWIN BROOKS
Credential : M.D.
Telephone Number : 817-870-0172
Provider Enumeration Date : 12/02/2013
Last Update Date : 01/15/2014

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Directions to “BROOKS SURGERY CLINIC, PLLC ” Practice Location

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