Provider Demographics
NPI:1104892876
Name:BROOKS, BONNIE JEAN (MD)
Entity type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:JEAN
Last Name:BROOKS
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Gender:F
Credentials:MD
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Mailing Address - Street 1:11803 JEFFERSON AVE
Mailing Address - Street 2:STE 140
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-2565
Mailing Address - Country:US
Mailing Address - Phone:757-594-1803
Mailing Address - Fax:757-594-1828
Practice Address - Street 1:9500 RICHMOND HIGHWAY
Practice Address - Street 2:SENTARA FAMILY MEDICINE PHYSICIANS
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-2124
Practice Address - Country:US
Practice Address - Phone:571-800-8915
Practice Address - Fax:833-954-5512
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2024-09-24
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Provider Licenses
StateLicense IDTaxonomies
VA0101245687207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COG31448Medicare UPIN