Provider Demographics
NPI:1891809026
Name:BRINER, RUDY (MD)
Entity Type:Individual
Prefix:DR
First Name:RUDY
Middle Name:
Last Name:BRINER
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 1:14485 STATE HIGHWAY 30
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-4825
Mailing Address - Country:US
Mailing Address - Phone:979-220-7738
Mailing Address - Fax:
Practice Address - Street 1:8441 STATE HIGHWAY 47 STE 4300
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77807-3235
Practice Address - Country:US
Practice Address - Phone:979-776-8896
Practice Address - Fax:979-774-0716
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3179207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00301978OtherMEDICARE RAILROAD
TX8U5900OtherBLUE CROSS PROVIDER NUMBE
TX110199005Medicaid
TX8F1711Medicare PIN
TXC13765Medicare UPIN