Provider Demographics
NPI:1992237721
Name:BROOKS, BRADLEY (DO)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:
Last Name:BROOKS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 MONTLIMAR DR
Mailing Address - Street 2:STE A-210
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-1713
Mailing Address - Country:US
Mailing Address - Phone:251-461-4243
Mailing Address - Fax:251-450-4323
Practice Address - Street 1:1015 MONTLIMAR DR
Practice Address - Street 2:STE A-210
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-1713
Practice Address - Country:US
Practice Address - Phone:251-461-4243
Practice Address - Fax:251-450-4323
Is Sole Proprietor?:No
Enumeration Date:2017-03-30
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO.19162084A0401X, 2084P0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program