Provider Demographics
NPI:1609865948
Name:BRINGHURST, DIRK C (MD)
Entity Type:Individual
Prefix:
First Name:DIRK
Middle Name:C
Last Name:BRINGHURST
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 140349
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99514-0349
Mailing Address - Country:US
Mailing Address - Phone:907-792-7920
Mailing Address - Fax:907-792-7901
Practice Address - Street 1:2741 DEBARR RD
Practice Address - Street 2:SUITE 401
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2961
Practice Address - Country:US
Practice Address - Phone:907-792-7920
Practice Address - Fax:907-792-7901
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-19
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4985210-12052085R0202X
AK60062085R0202X
WY4597A2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E88345Medicare UPIN