Provider Demographics
NPI:1205899671
Name:BRINKMAN, MARK F (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:F
Last Name:BRINKMAN
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 1:426 S WIDE RIVER RD
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-7149
Mailing Address - Country:US
Mailing Address - Phone:208-777-1019
Mailing Address - Fax:
Practice Address - Street 1:1705 N GOVERNMENT WAY
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-3444
Practice Address - Country:US
Practice Address - Phone:208-765-8585
Practice Address - Fax:208-765-8486
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM6488174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID001704900Medicaid
IDG46475Medicare UPIN
ID1130757Medicare ID - Type UnspecifiedPROVIDER NUMBER