Healthcare Provider Details

I. General information

NPI: 1861480386
Provider Name (Legal Business Name): MARK R BRINKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7401 SOUTH MAIN ST
HOUSTON TX
77030-4509
US

IV. Provider business mailing address

7401 SOUTH MAIN ST
HOUSTON TX
77030-4509
US

V. Phone/Fax

Practice location:
  • Phone: 713-799-2300
  • Fax: 713-794-3380
Mailing address:
  • Phone: 713-799-2300
  • Fax: 713-794-3380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License NumberJ4727
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberJ4727
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: