Provider Demographics
NPI:1467652875
Name:BRIMHALL, IAN KAY (DO)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:KAY
Last Name:BRIMHALL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 LAKE OTIS PKWY STE 108
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5230
Mailing Address - Country:US
Mailing Address - Phone:907-563-3145
Mailing Address - Fax:833-464-5196
Practice Address - Street 1:4100 LAKE OTIS PKWY STE 108
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5230
Practice Address - Country:US
Practice Address - Phone:907-563-3145
Practice Address - Fax:833-464-5196
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015602207X00000X
AZ4782207X00000X
AK191513207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ122726OtherRENDERING PROVIDER TRANSACTION ACCESS NUMBER(PTAN)
AZ316896Medicaid