Provider Demographics
NPI:1053360487
Name:BROOKS, RICHARD B (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:B
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 1:3401 PGA BLVD STE 440
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-2825
Mailing Address - Country:US
Mailing Address - Phone:561-799-2831
Mailing Address - Fax:
Practice Address - Street 1:3401 PGA BLVD STE 440
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-2825
Practice Address - Country:US
Practice Address - Phone:561-799-2831
Practice Address - Fax:561-429-3184
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1330212084N0400X
FLME1519992084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00593875Medicaid
C49882Medicare UPIN
NY00593875Medicaid