Provider Demographics
NPI:1346390010
Name:BRISCOE, WILLIAM C (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:C
Last Name:BRISCOE
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 1:4411 BEE RIDGE RD
Mailing Address - Street 2:295
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-2514
Mailing Address - Country:US
Mailing Address - Phone:941-924-8888
Mailing Address - Fax:941-924-8811
Practice Address - Street 1:4370 S TAMIAMI TRL
Practice Address - Street 2:SUITE 151
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-3412
Practice Address - Country:US
Practice Address - Phone:941-924-8888
Practice Address - Fax:941-924-8811
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME128452084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11810OtherBLUE CROSS BLUE SHIELD
FL59-3063987OtherTAX ID
FL59-3063987OtherTAX ID
FL11810AMedicare ID - Type Unspecified