Provider Demographics
NPI:1316185499
Name:BRINKER, TIMOTHY MARTIN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:MARTIN
Last Name:BRINKER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2960 TONGASS AVENUE
Mailing Address - Street 2:
Mailing Address - City:KETCHIKAN
Mailing Address - State:AK
Mailing Address - Zip Code:99901-5742
Mailing Address - Country:US
Mailing Address - Phone:907-228-4900
Mailing Address - Fax:800-852-3264
Practice Address - Street 1:2960 TONGASS AVENUE
Practice Address - Street 2:
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-5742
Practice Address - Country:US
Practice Address - Phone:907-228-4900
Practice Address - Fax:800-852-3264
Is Sole Proprietor?:No
Enumeration Date:2009-01-28
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ASBR96799363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1574400Medicaid
AKTEZD44YZRVMedicare PIN
AS642300Medicare Oscar/Certification
AK1574400Medicaid
AS640001Medicare Oscar/Certification