Individual
MR. STEPHEN RUSSELL BROOKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NAVY IDC
Contact information
Practice address
472 POLARIS ST BLDG 586, VIRGINIA BEACH, VA 23461-1935
(910) 741-9612
Mailing address
472 POLARIS ST BLDG 586, VIRGINIA BEACH, VA 23461-1935
(910) 741-9612
Taxonomy
Speciality
Code
Description
License number
State
374700000X
Technician
Primary
1163448811
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1163448811
UNITED STATES NAVY
VA
Enumeration date
03/27/2022
Last updated
03/27/2022
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