Healthcare Provider Details

I. General information

NPI: 1669430450
Provider Name (Legal Business Name): SHERI LOUISE BRINKER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 11/23/2020
Certification Date: 11/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W OTTLEY AVE
FRUITA CO
81521-2118
US

IV. Provider business mailing address

PO BOX 130
FRUITA CO
81521-0130
US

V. Phone/Fax

Practice location:
  • Phone: 970-858-2149
  • Fax: 970-858-2200
Mailing address:
  • Phone: 970-858-2186
  • Fax: 970-858-2208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35087287
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberDR.0054931
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number216533
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number35087287
License Number StateOH
# 5
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberDR.0054931
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: