# MR. STEPHEN RUSSELL BROOKS

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1780334276
- **Gender:** Man
- **Credential:** NAVY IDC

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 374700000X | Technician | 1163448811 | VA | Yes |

## Other

- **Enumeration date:** 03/27/2022
- **Last updated:** 03/27/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1163448811 | UNITED STATES NAVY | VA |