Provider Demographics
NPI:1902898190
Name:BRINK, BRUCE CARLTON JR (DO)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:CARLTON
Last Name:BRINK
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1808 SHERMAN DR
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:IN
Mailing Address - Zip Code:47670-1043
Mailing Address - Country:US
Mailing Address - Phone:812-385-3401
Mailing Address - Fax:812-385-3401
Practice Address - Street 1:410 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:IN
Practice Address - Zip Code:47670-1516
Practice Address - Country:US
Practice Address - Phone:812-386-7522
Practice Address - Fax:812-386-1097
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2017-12-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN02000610A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100122180AMedicaid
IN300003786Medicaid