Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | M3931 | TX |
NPI | 1942245196 |
---|---|
Provider Name | Russell Deane Briggs |
First Address | Austin, TX 78746-5640 |
Second Address | Austin, TX 78746-5640 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2006 |
Last Update Date | 30/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H92907 | (02) | TX |