Healthcare Provider Details

I. General information

NPI: 1619083722
Provider Name (Legal Business Name): KEVIN L BRINK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 08/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 JANES RD
ARCATA CA
95521-4742
US

IV. Provider business mailing address

PO BOX 3669
SANTA ROSA CA
95402-3669
US

V. Phone/Fax

Practice location:
  • Phone: 707-442-4848
  • Fax:
Mailing address:
  • Phone: 707-535-4300
  • Fax: 707-535-4311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG59216
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: