MEDICARE: STEWART T BROOKS PA

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	363AS0400X	Surgical Physician Assistant	PA10004055	WA
2	363AS0400X	Surgical Physician Assistant	PA06723	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0211459	OTHER	WA	L&I NUMBER

General Provider Information

NPI Number	:	1639174170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEWART T BROOKS PA

Provider Business Mailing Address
First Line	:	8441 STATE HIGHWAY 47 STE 4300
Second Line	:
City	:	BRYAN
State	:	TX
Zip	:	77807-3235
Country	:	US
Telephone Number	:	979-776-8896
Fax Number	:

Provider Business Practice Location Address
First Line	:	8441 STATE HIGHWAY 47 STE 4300
Second Line	:
City	:	BRYAN
State	:	TX
Zip	:	77807-3235
Country	:	US
Telephone Number	:	979-776-8896
Fax Number	:

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

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	08/12/2015

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Directions to “ STEWART T BROOKS PA” Practice Location

Language	Start Address	Practice Location

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