Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 4315 | KY |
NPI | 1427145366 |
---|---|
Provider Name | Mr. C Michael Brinker |
First Address | Florence, KY 41042 |
Second Address | Florence, KY 41042 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 08/07/2007 |