Provider Demographics
NPI:1205983921
Name:BROOKS, STEVEN DOUGLAS (LSA)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:DOUGLAS
Last Name:BROOKS
Suffix:
Gender:M
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 W JEFFERSON ST
Mailing Address - Street 2:#150
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-6329
Mailing Address - Country:US
Mailing Address - Phone:956-544-8144
Mailing Address - Fax:956-544-8142
Practice Address - Street 1:800 W JEFFERSON ST
Practice Address - Street 2:#150
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-6329
Practice Address - Country:US
Practice Address - Phone:956-544-8144
Practice Address - Fax:956-544-8142
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00031246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
8N4381OtherBLUE CROSS BLUE SHIELD #