Provider Demographics
NPI:1437132180
Name:BRINK, DAVID A (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:BRINK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 ALEXANDER DR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-3003
Mailing Address - Country:US
Mailing Address - Phone:334-671-1696
Mailing Address - Fax:334-794-0721
Practice Address - Street 1:1900 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-3008
Practice Address - Country:US
Practice Address - Phone:334-793-9511
Practice Address - Fax:334-794-0721
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL178272085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009931908Medicaid
AL009931909Medicaid
AL009931914Medicaid
AL000024253Medicaid
AL009931914Medicaid
AL000024253Medicare PIN