Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 23699 | TX |
NPI | 1063533354 |
---|---|
Provider Name | Dr. Patrick Briscoe |
First Address | Longview, TX 75605-2948 |
Second Address | Longview, TX 75605-2948 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2007 |
Last Update Date | 20/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1114234556 | ULTRA ORTHODONTICS (01) | TX |
1427168541 | SHERMAN & BRISCOE ORTHODONTICS (01) | TX |