MEDICARE: DR. DAVID A BROOKS PHD

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	103G00000X	Clinical Neuropsychologist	278	ND
2	103TC0700X	Clinical Psychologist	278	ND
3	103T00000X	Psychologist	278	ND

Other Identifiers

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

General Provider Information

NPI Number	:	1790839934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID A BROOKS PHD

Provider Business Mailing Address
First Line	:	3000 N 14TH ST STE 3A
Second Line	:
City	:	BISMARCK
State	:	ND
Zip	:	58503-0697
Country	:	US
Telephone Number	:	701-401-5342
Fax Number	:	701-751-3947

Provider Business Practice Location Address
First Line	:	3000 N 14TH ST STE 3A
Second Line	:
City	:	BISMARCK
State	:	ND
Zip	:	58503-0697
Country	:	US
Telephone Number	:	701-401-5342
Fax Number	:	701-751-3947

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

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	01/22/2024

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