Basic Information
| Provider Information | |||||||||
| NPI: | 1225002041 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BROOCKER | ||||||||
| FirstName: | WARREN | ||||||||
| MiddleName: | ALAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10710 MIDLOTHIAN TURNPIKE | ||||||||
| Address2: | STE 200 | ||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232354759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8048972100 | ||||||||
| FaxNumber: | 8048979074 | ||||||||
| Practice Location | |||||||||
| Address1: | 10710 MIDLOTHIAN TURNPIKE | ||||||||
| Address2: | STE 200 | ||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232354759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8048972100 | ||||||||
| FaxNumber: | 8048979074 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2006 | ||||||||
| LastUpdateDate: | 03/03/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 0101026911 | VA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 6290558 | 05 | VA | MEDICAID |