1629682836 NPI number — MR. GREGORY DAVID BROOKS SR. RPH

Table of content: MR. GREGORY DAVID BROOKS SR. RPH (NPI 1629682836)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629682836 NPI number — MR. GREGORY DAVID BROOKS SR. RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROOKS
Provider First Name:
GREGORY
Provider Middle Name:
DAVID
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
SR.
Provider Credential Text:
RPH
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629682836
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/04/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14001 HWY 29
Provider Second Line Business Mailing Address:
SUITE 202A
Provider Business Mailing Address City Name:
LIBERTY HILL
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78642
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-402-2231
Provider Business Mailing Address Fax Number:
888-905-0581

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14001 HWY 29
Provider Second Line Business Practice Location Address:
SUITE 202A
Provider Business Practice Location Address City Name:
LIBERTY HILL
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78642
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-402-2231
Provider Business Practice Location Address Fax Number:
888-905-0581
Provider Enumeration Date:
09/04/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  32069 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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