Provider Demographics
NPI:1609847771
Name:BRINKLEY, AVERY B JR (MD)
Entity Type:Individual
Prefix:
First Name:AVERY
Middle Name:B
Last Name:BRINKLEY
Suffix:JR
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 773029
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34477-3029
Mailing Address - Country:US
Mailing Address - Phone:352-291-0014
Mailing Address - Fax:352-291-0057
Practice Address - Street 1:3143 SW 32ND AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-4403
Practice Address - Country:US
Practice Address - Phone:352-291-0014
Practice Address - Fax:352-291-0057
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME357472085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL17469OtherBCBS
FL061623100Medicaid
FL061623100Medicaid
FL17469YMedicare ID - Type Unspecified