Provider Demographics
NPI:1811003031
Name:BRINKMAN, LUCAS (DO)
Entity Type:Individual
Prefix:
First Name:LUCAS
Middle Name:
Last Name:BRINKMAN
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 1:115 SCHULT RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:IA
Mailing Address - Zip Code:50630
Mailing Address - Country:US
Mailing Address - Phone:563-237-5316
Mailing Address - Fax:563-237-6337
Practice Address - Street 1:115 SCHULT RIDGE RD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:IA
Practice Address - Zip Code:50630-9582
Practice Address - Country:US
Practice Address - Phone:563-237-5316
Practice Address - Fax:563-237-6337
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3824207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1811003031Medicaid
IA1811003031OtherBLUE SHIELD
IALB1436011Medicare PIN