Jack Glen Brooks, MD
Individual provider Active NPI Diagnostic Radiology Physician · Alrington, TX
NPI 1427080845 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1427080845
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Diagnostic Radiology Physician 2085R0202X
- License
- D2754 (TX)
- Practice address
- 601 W Arbrook Blvd
Healthsouth Diagnostic Center of Arlington
Alrington, TX 76014-3701 - Phone
- (817) 472-0801
- Fax
- (817) 472-0309
- NPI assigned
- Jul 7, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D2754 | TX | MD | Diagnostic Radiology Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | D2754 | TX | Yes |
Addresses
Primary practice location
601 W Arbrook Blvd
Healthsouth Diagnostic Center of Arlington
Alrington, TX 76014-3701
Mailing address
1824 Southpark Drive
Arlington, TX 76013-4211
Phone (817) 429-1645
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| C13798 | Medicaid | TX |
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.