Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 02952 | KY |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | 34.007963 | OH |
NPI | 1497785737 |
---|---|
Provider Name | Jon A. Brinkman |
First Address | Ashland, KY 41105-2379 |
Second Address | Ashland, KY 41101-2885 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 18/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2386029 | (05) | OH |
64126204 | (05) | KY |
H78835 | (02) | KY |