Provider Demographics
NPI:1033113014
Name:BRISSETT, ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:BRISSETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1977 BUTLER BLVD
Mailing Address - Street 2:E6.100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4101
Mailing Address - Country:US
Mailing Address - Phone:713-798-3223
Mailing Address - Fax:713-798-2774
Practice Address - Street 1:1977 BUTLER BLVD
Practice Address - Street 2:E6.100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4101
Practice Address - Country:US
Practice Address - Phone:713-798-3223
Practice Address - Fax:713-798-2774
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9532207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163069101Medicaid
TX8B3587Medicare PIN
G60982Medicare UPIN
TX8B3831Medicare PIN