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General NPI Number Information
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NPI Number | 1750722880
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Entity Type | Organization
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Legal Business Name | RICHARD WARREN BRINKMAN INC
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Dates
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Enumeration Date | 07/17/2013
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Last Update Date | 08/15/2013
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Provider Practice Location Address
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Address Line | 1711 DESTINY LN SUITE 118
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City | BOWLING GREEN
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State | KY
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Zip | 42104-1066
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Country | US
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Telephone | 270-782-8866
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Fax | 270-715-8346
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Provider Business Mailing Address
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Address Line | 1711 DESTINY LN SUITE 118
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City | BOWLING GREEN
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State | KY
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Zip | 42104-1066
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Country | US
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Telephone | 270-782-8866
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Fax | 270-715-8346
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Authorized Official
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Title or Position | OWNER
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Name | DR. RICHARD WARREN BRINKMAN
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Credential | MD
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Telephone | 270-782-8866
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 38409
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License Number State | KY
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