Provider Demographics
NPI:1255337390
Name:BROOKS, BLAKE JAY (MD)
Entity type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:JAY
Last Name:BROOKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1205 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-2125
Mailing Address - Country:US
Mailing Address - Phone:573-499-0642
Mailing Address - Fax:573-449-1787
Practice Address - Street 1:1205 W BROADWAY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-2125
Practice Address - Country:US
Practice Address - Phone:573-499-0642
Practice Address - Fax:573-449-1787
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2022-10-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO119892207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1963097OtherFIRST HEALTH
MO42482OtherHEALTHCARE USA
MOH51820OtherMERCY
MO539285OtherHEALTHLINK
MO431535214OtherTRICARE
MO000623655OtherHUMANA
MO143480OtherGROUP HEALTH PLANS
MO208373407Medicaid
MO3100264OtherUNITED HEALTHCARE
MOP01764602OtherRAILROAD MEDICARE
MO110245813OtherRAILROAD MEDICARE
MO178793OtherBLUE CROSS BLUE SHIELD
MO7359531OtherAETNA
MO208373407Medicaid