Basic Information
Provider Information
NPI: 1831486869
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BROOKS
FirstName: CHRISTOPHER
MiddleName: BENJAMIN
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2817 REILLY ST
Address2: WOMACK ARMY MEDICAL CENTER
City: FORT BRAGG
State: NC
PostalCode: 283107324
CountryCode: US
TelephoneNumber: 9109078922
FaxNumber: 9109076069
Practice Location
Address1: WOMACK ARMY MEDICAL CENTER 2817 REILLY ST
Address2: FAMILY MEDICINE CLINIC
City: FORT BRAGG
State: NC
PostalCode: 283107324
CountryCode: US
TelephoneNumber: 9109078007
FaxNumber: 9109078630
Other Information
ProviderEnumerationDate: 06/28/2011
LastUpdateDate: 11/09/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XP6589TXY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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