Active NPI
Therdo Brooks III, CRT
- Radiologic Technologist
- Goodyear, AZ
National Provider Identifier
1124490693
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Radiologic Technologist
- License
- 18024
- Practice address
- 14450 W Avalon Dr
Goodyear, AZ 85395-8315 - Phone
- (602) 466-4926
- NPI assigned
- Oct 23, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Radiologic Technologist | 247100000X | 18024 | AZ | Primary |
Addresses
Primary practice location
14450 W Avalon Dr
Goodyear, AZ 85395-8315
Mailing address
14450 W Avalon Dr
Goodyear, AZ 85395-8315
Phone (602) 466-4926
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18024 | AZ | MD | Radiologic Technologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1445558400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1445558400000",
"number": "1124490693",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14450 W AVALON DR",
"city": "GOODYEAR",
"state": "AZ",
"postal_code": "853958315",
"telephone_number": "602-466-4926"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14450 W AVALON DR",
"city": "GOODYEAR",
"state": "AZ",
"postal_code": "853958315",
"telephone_number": "602-466-4926"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROOKS",
"first_name": "THERDO",
"name_suffix": "III",
"credential": "CRT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-10-23",
"last_updated": "2015-10-23",
"status": "A"
},
"taxonomies": [
{
"code": "247100000X",
"taxonomy_group": "",
"desc": "Radiologic Technologist",
"state": "AZ",
"license": "18024",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Goodyear, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.