Provider Demographics
NPI:1306899638
Name:BROOKS, STEPHEN WILLARD (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:WILLARD
Last Name:BROOKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 MAIN ST BLDG B
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-3112
Mailing Address - Country:US
Mailing Address - Phone:508-775-0800
Mailing Address - Fax:508-771-8565
Practice Address - Street 1:6 MAIN ST BLDG B
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3112
Practice Address - Country:US
Practice Address - Phone:508-775-0800
Practice Address - Fax:508-771-8565
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA72357174400000X, 208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No174400000XOther Service ProvidersSpecialist
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0000029456OtherBMC
MA3074530OtherAETNA
MAJ09482OtherBLUECROSS BLUESHIELD MA
MA3058956Medicaid
MA760986OtherTUFTS HEALTH PLAN
MA020013142OtherRAILROAD MEDICARE
MA8394OtherHARVARD PILGRIM HEALTHCAR
MAB20265301OtherCIGNA
MA0000029456OtherBMC
MA3058956Medicaid