MEDICARE: DAVID BRINK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	108189	MO
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	036103867	IL
3	207ZP0213X	Pediatric Pathology Physician	108189	MO
4	207ZP0213X	Pediatric Pathology Physician	036103867	IL

General Provider Information

NPI Number	:	1922054196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID BRINK MD

Provider Business Mailing Address
First Line	:	1402 S GRAND BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63104-1004
Country	:	US
Telephone Number	:	314-566-7697
Fax Number	:	314-977-7615

Provider Business Practice Location Address
First Line	:	1402 S GRAND BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63104-1004
Country	:	US
Telephone Number	:	314-566-7697
Fax Number	:	314-977-7615

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	02/23/2021

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Directions to “ DAVID BRINK MD” Practice Location

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