Provider Demographics
NPI:1669430450
Name:BRINKER, SHERI LOUISE (MD)
Entity type:Individual
Prefix:
First Name:SHERI
Middle Name:LOUISE
Last Name:BRINKER
Suffix:
Gender:F
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 130
Mailing Address - Street 2:
Mailing Address - City:FRUITA
Mailing Address - State:CO
Mailing Address - Zip Code:81521-0130
Mailing Address - Country:US
Mailing Address - Phone:970-858-2186
Mailing Address - Fax:970-858-2208
Practice Address - Street 1:300 W OTTLEY AVE
Practice Address - Street 2:
Practice Address - City:FRUITA
Practice Address - State:CO
Practice Address - Zip Code:81521-2118
Practice Address - Country:US
Practice Address - Phone:970-858-2149
Practice Address - Fax:970-858-2200
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350872872085R0202X, 208D00000X
CODR.0054931208D00000X, 2085R0202X
MA216533208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2623361Medicaid
OH000000207338OtherUNISON
OH000000384122OtherANTHEM
OH341893458OtherMMOH
OH7717448OtherAETNA
H32257Medicare UPIN
OH2623361Medicaid
OH4175332Medicare PIN
OHP00289368Medicare PIN