MEDICARE: RALPH ANTHONY BROOKS M.D.

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	207N00000X	Dermatology Physician	H3656	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2313807	OTHER	TX	BLUE CROSS/BLUE SHIELD
2	H3656	OTHER	TX	MEDICAL LICENSE

General Provider Information

NPI Number	:	1467565762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RALPH ANTHONY BROOKS M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1905
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76101-1905
Country	:	US
Telephone Number	:	817-521-2369
Fax Number	:	817-346-7408

Provider Business Practice Location Address
First Line	:	6116 OAKBEND TRL
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-3925
Country	:	US
Telephone Number	:	817-521-2369
Fax Number	:	817-346-7408

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

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	09/30/2020

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