Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DRP1570 | FL |
NPI | 1033567367 |
---|---|
Provider Name | Matthew Brian Brinker |
First Address | Gainesville, FL 32610-0416 |
Second Address | Gainesville, FL 32610-0416 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2016 |
Last Update Date | 26/05/2016 |