Provider Demographics
NPI:1477633832
Name:BROLINSON, PER GUNNAR (DO)
Entity Type:Individual
Prefix:DR
First Name:PER
Middle Name:GUNNAR
Last Name:BROLINSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1572
Mailing Address - Street 2:
Mailing Address - City:RADFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24143-1572
Mailing Address - Country:US
Mailing Address - Phone:540-639-6736
Mailing Address - Fax:540-633-1524
Practice Address - Street 1:101 PROFESSIONAL PARK DR SE
Practice Address - Street 2:SUITE 3
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-6685
Practice Address - Country:US
Practice Address - Phone:540-951-4000
Practice Address - Fax:540-633-1524
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102201326204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008463A66Medicare ID - Type Unspecified