Provider Demographics
NPI:1952694234
Name:JACK G BROOKS MD PA
Entity type:Organization
Organization Name:JACK G BROOKS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RADIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:G
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-274-7373
Mailing Address - Street 1:2726 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-3100
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:817-274-1176
Practice Address - Street 1:2726 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-3100
Practice Address - Country:US
Practice Address - Phone:817-274-7373
Practice Address - Fax:817-274-1176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-19
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD2754261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology