Provider Demographics
NPI:1437136603
Name:BRINK, DANIEL L (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:L
Last Name:BRINK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:909 SW ORALABOR RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-7004
Mailing Address - Country:US
Mailing Address - Phone:515-963-4400
Mailing Address - Fax:515-964-9838
Practice Address - Street 1:909 SW ORALABOR RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-7004
Practice Address - Country:US
Practice Address - Phone:515-963-4400
Practice Address - Fax:515-964-9838
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IAMD-33454208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1210666Medicaid
IA1437136603Medicaid
IA2210666Medicaid
IA1210666Medicaid
IAI3025Medicare PIN