Provider Demographics
NPI:1033172598
Name:BRIZZEE, MICHAEL DWAYNE (IDC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:DWAYNE
Last Name:BRIZZEE
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 SAN SABA DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78374-1455
Mailing Address - Country:US
Mailing Address - Phone:361-776-5767
Mailing Address - Fax:
Practice Address - Street 1:119 SAN SABA DR
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:TX
Practice Address - Zip Code:78374-1455
Practice Address - Country:US
Practice Address - Phone:361-776-5767
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman