Provider Demographics
NPI:1013203793
Name:BRISSEAU, GUY FREDERICK (MD)
Entity Type:Individual
Prefix:DR
First Name:GUY
Middle Name:FREDERICK
Last Name:BRISSEAU
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Gender:M
Credentials:MD
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Mailing Address - Street 1:5850 UNIVERSITY AVENUE
Mailing Address - Street 2:IWK - DEPT PAEDIATRIC SURGERY
Mailing Address - City:HALIFAX
Mailing Address - State:NS
Mailing Address - Zip Code:B3K6R8
Mailing Address - Country:CA
Mailing Address - Phone:902-470-8113
Mailing Address - Fax:902-470-7260
Practice Address - Street 1:5850 UNIVERSITY AVENUE
Practice Address - Street 2:IWK DEPT OF PEDIATRIC SURGERY
Practice Address - City:HALIFAX
Practice Address - State:NS
Practice Address - Zip Code:B3K6R8
Practice Address - Country:CA
Practice Address - Phone:902-470-8113
Practice Address - Fax:902-470-7260
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
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Provider Licenses
StateLicense IDTaxonomies
ZZ107712086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery