Provider Demographics
NPI:1538142484
Name:BRINKER, JEFFREY RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:RICHARD
Last Name:BRINKER
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:PO BOX 2699
Mailing Address - Street 2:ATTN: SHMG/HPE
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32513-2699
Mailing Address - Country:US
Mailing Address - Phone:850-416-7734
Mailing Address - Fax:850-934-7276
Practice Address - Street 1:1399 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32563-3451
Practice Address - Country:US
Practice Address - Phone:850-416-7734
Practice Address - Fax:850-934-7276
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0067591207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G89039Medicare UPIN