MEDICARE: JERRY BROOKSHER GEE II MD

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
1	2080N0001X	Neonatal-Perinatal Medicine Physician	K0041	TX
2	2080N0001X	Neonatal-Perinatal Medicine Physician	MD020328	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	84776X	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1174610463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERRY BROOKSHER GEE II MD

Provider Business Mailing Address
First Line	:	PO BOX 270898
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77277-0898
Country	:	US
Telephone Number	:	713-796-0003
Fax Number	:	713-796-0005

Provider Business Practice Location Address
First Line	:	5615 KIRBY DRIVE
Second Line	:	SUITE 440
City	:	HOUSTON
State	:	TX
Zip	:	77005
Country	:	US
Telephone Number	:	713-796-0003
Fax Number	:	713-796-0005

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	07/09/2007

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