Individual
BROOKS BARHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1030 RIVER OAKS DR, JACKSON, MS 39232-9553
(601) 936-0494
Mailing address
PO BOX 4710, JACKSON, MS 39296-4710
(601) 936-0494
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
17522
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08423212
—
MS
Enumeration date
07/31/2006
Last updated
04/14/2009
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