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NPI Code Detail

MEDICARE: MR. JACK GLEN BROOKS MD

MEDICARE: MR. JACK GLEN BROOKS 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
12085R0202XDiagnostic Radiology PhysicianD2754TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1427080845
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JACK GLEN BROOKS MD
Provider Business Mailing Address
First Line : 1824 SOUTHPARK DRIVE
Second Line :
City : ARLINGTON
State : TX
Zip : 76013-4211
Country : US
Telephone Number : 817-429-1645
Fax Number : 817-451-3796
Provider Business Practice Location Address
First Line : 601 W ARBROOK BLVD
Second Line : HEALTHSOUTH DIAGNOSTIC CENTER OF ARLINGTON
City : ALRINGTON
State : TX
Zip : 76014-3701
Country : US
Telephone Number : 817-472-0801
Fax Number : 817-472-0309
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2006
Last Update Date : 07/08/2007

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