Provider Demographics
NPI:1366428104
Name:BRINKERHOFF, DOUGLAS E (DO)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:E
Last Name:BRINKERHOFF
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 CIBECUE CIRCLE RD
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:AZ
Mailing Address - Zip Code:85550-0208
Mailing Address - Country:US
Mailing Address - Phone:928-475-7219
Mailing Address - Fax:
Practice Address - Street 1:223 CIBECUE CIRCLE RD
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:AZ
Practice Address - Zip Code:85550-0208
Practice Address - Country:US
Practice Address - Phone:928-475-7219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1428207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0835990OtherBCBS AZ
AZ1Z7321OtherHEALTHNET
AZ080135404Medicare ID - Type UnspecifiedRAILROAD MEDICARE
AZZ25400Medicare PIN
AZ1Z7321OtherHEALTHNET