Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 2270 | CO |
NPI | 1073699351 |
---|---|
Provider Name | Dr. Douglas Paul Brisson |
First Address | Longmont, CO 80504-8511 |
Second Address | Longmont, CO 80504-8511 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2006 |
Last Update Date | 02/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
202497907 | (02) | CO |