MEDICARE: LESA BROOKES 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	208000000X	Pediatrics Physician	12620	NV

General Provider Information

NPI Number	:	1548249451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESA BROOKES MD

Provider Business Mailing Address
First Line	:	8440 W LAKE MEAD BLVD STE 104
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-7648
Country	:	US
Telephone Number	:	702-821-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	8440 W LAKE MEAD BLVD STE 104
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-7648
Country	:	US
Telephone Number	:	702-821-2000
Fax Number	:

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

Provider Enumeration Date	:	01/10/2006
Last Update Date	:	12/23/2020

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