Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | J9532 | TX |
NPI | 1033113014 |
---|---|
Provider Name | Dr. Anthony Brissett |
First Address | Houston, TX 77030-4101 |
Second Address | Houston, TX 77030-4101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2005 |
Last Update Date | 08/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
163069101 | (05) | TX |
G60982 | (02) |