Provider Demographics
NPI:1336129758
Name:BRIMBERRY, RONALD K (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:K
Last Name:BRIMBERRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:601 W MAPLE AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-5379
Mailing Address - Country:US
Mailing Address - Phone:479-750-6585
Mailing Address - Fax:479-750-6594
Practice Address - Street 1:601 W MAPLE AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-5379
Practice Address - Country:US
Practice Address - Phone:479-750-6585
Practice Address - Fax:479-750-6594
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-6028207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR105374001Medicaid
AR390702OtherHEALTHLINK
AR971868OtherFIRST HEALTH
AR080153473OtherRAILROAD MEDICARE
AR1353054OtherUNITED HEALTH CARE
AR11671000000OtherQUAL CHOICE
AR50638OtherBCBS
AR5498573OtherAETNA
AR390702OtherHEALTHLINK
AR50638OtherBCBS