Basic Information
Provider Information
NPI: 1619180320
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BRINKMANN
FirstName: COLIN
MiddleName: S
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 551420
Address2:  
City: FORT LAUDERDALE
State: FL
PostalCode: 333551420
CountryCode: US
TelephoneNumber: 8002433839
FaxNumber: 9548392569
Practice Location
Address1: 19686 PEACHTREE ROAD NW
Address2:  
City: ATLANTA
State: GA
PostalCode: 303091281
CountryCode: US
TelephoneNumber: 4043511745
FaxNumber: 4043517121
Other Information
ProviderEnumerationDate: 05/08/2007
LastUpdateDate: 09/29/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000X059131GAY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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