Basic Information
| Provider Information | |||||||||
| NPI: | 1558327502 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCBROOM | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1601 BROOK AVE | ||||||||
| Address2: | |||||||||
| City: | WICHITA FALLS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 763015619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9407239226 | ||||||||
| FaxNumber: | 9407239217 | ||||||||
| Practice Location | |||||||||
| Address1: | 1601 BROOK AVE | ||||||||
| Address2: | |||||||||
| City: | WICHITA FALLS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 763015619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9407239226 | ||||||||
| FaxNumber: | 9407239217 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2006 | ||||||||
| LastUpdateDate: | 09/24/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | F6922 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
ID Information
| ID | Type | State | Issuer | Description | 134085303 | 05 | TX | MEDICAID |