Provider Demographics
NPI:1821181751
Name:BRINEGAR, BRIAN (PA)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:
Last Name:BRINEGAR
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2285 CORPORATE CIR
Mailing Address - Street 2:STE 200
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7759
Mailing Address - Country:US
Mailing Address - Phone:702-360-2763
Mailing Address - Fax:949-783-2880
Practice Address - Street 1:3011 S LINDSAY RD
Practice Address - Street 2:STE 111
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-4332
Practice Address - Country:US
Practice Address - Phone:480-507-5011
Practice Address - Fax:480-355-1996
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16716363A00000X
AZ4579363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ04297Medicare UPIN
CABF200ZMedicare PIN