Basic Information
Provider Information
NPI: 1417228792
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BRINKER
FirstName: ALYSON
MiddleName: JEAN
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 801 YORK ST
Address2:  
City: MANITOWOC
State: WI
PostalCode: 542204630
CountryCode: US
TelephoneNumber: 9206639008
FaxNumber: 9206841439
Practice Location
Address1: 540 FONTAINE ST
Address2:  
City: PENSACOLA
State: FL
PostalCode: 325032019
CountryCode: US
TelephoneNumber: 8002437546
FaxNumber: 8504848223
Other Information
ProviderEnumerationDate: 01/19/2012
LastUpdateDate: 05/17/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/17/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207N00000XME147165FLY Allopathic & Osteopathic PhysiciansDermatology 

No ID Information.


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