Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2081S0010X | Sports Medicine | 07000514 | IN |
N | 213ES0000X | Sports Medicine | 07000514 | IN |
Y | 213ES0103X | Foot & Ankle Surgery | 07000514 | IN |
NPI | 1487647277 |
---|---|
Provider Name | Bruce J Brincko |
First Address | Crown Point, IN 46307-3538 |
Second Address | Crown Point, IN 46307-3538 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2005 |
Last Update Date | 10/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100168570 | (05) | IN |
T34880 | (02) | IN |