Provider Demographics
NPI:1477612372
Name:DRISKILL, BRENT R (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:R
Last Name:DRISKILL
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 1:1656 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103
Mailing Address - Country:US
Mailing Address - Phone:202-870-2090
Mailing Address - Fax:
Practice Address - Street 1:4033 3RD AVE STE 104
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2136
Practice Address - Country:US
Practice Address - Phone:619-294-2350
Practice Address - Fax:619-296-5719
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036142067207Y00000X
VA0101240491207Y00000X
CAC146197207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology