# BOBBY J. BROOKS, M.D.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619005535
- **Authorized official:** BOBBY J. BROOKS M.D. (PRESIDENT)
- **Authorized official phone:** (270) 789-3410

## Contact information

- **Practice address:** 127 KINGSWOOD DR, CAMPBELLSVILLE, KY 42718-9634
- **Practice address phone:** (270) 789-3410
- **Practice address fax:** (270) 465-2449
- **Mailing address:** 127 KINGSWOOD DR, CAMPBELLSVILLE, KY 42718-9634
- **Mailing address phone:** (270) 789-3410
- **Mailing address fax:** (270) 465-2449

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 03/01/2007
- **Last updated:** 03/25/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000051793 | ANTHEM | KY |
| 01 | — | 01-00154 | UNITED HEALTHCARE | KY |
| 05 | — | 65902504 | — | KY |
| 05 | — | 78901006 | — | KY |