Provider Demographics
NPI:1083086870
Name:BRIOSCHI, CHARLES EDWARD JR (PA)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:EDWARD
Last Name:BRIOSCHI
Suffix:JR
Gender:M
Credentials:PA
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Mailing Address - Street 1:3340 E GOLDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1026
Mailing Address - Country:US
Mailing Address - Phone:208-452-3111
Mailing Address - Fax:208-452-3666
Practice Address - Street 1:910 NW 16TH STREET
Practice Address - Street 2:STE 205
Practice Address - City:FRUITLAND
Practice Address - State:ID
Practice Address - Zip Code:83619-2265
Practice Address - Country:US
Practice Address - Phone:208-452-3111
Practice Address - Fax:208-452-3666
Is Sole Proprietor?:No
Enumeration Date:2015-10-20
Last Update Date:2016-02-17
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Provider Licenses
StateLicense IDTaxonomies
IDPA-1317363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical