Provider Demographics
NPI:1598762635
Name:BRIZUELA, FELIX (DO)
Entity Type:Individual
Prefix:
First Name:FELIX
Middle Name:
Last Name:BRIZUELA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1271 SUNCREST TOWNE CENTRE
Mailing Address - Street 2:1271
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-3437
Mailing Address - Country:US
Mailing Address - Phone:304-598-3694
Mailing Address - Fax:304-598-1124
Practice Address - Street 1:1271 SUNCREST TOWN CENTRE DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-1876
Practice Address - Country:US
Practice Address - Phone:304-598-3694
Practice Address - Fax:304-212-5396
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH340082672084N0400X
WV20842084N0400X
PA0500817512084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV412764Medicaid
OHP00130893OtherRR MEDICARE
WVP00469049OtherRR MEDICARE
OH2484208Medicaid
PA3810000159Medicaid
WV412764Medicaid
WVWV4161D609Medicare PIN
PA3810000159Medicaid
PA740691PK7Medicare PIN
OH4127641Medicare PIN
WV4145832Medicare PIN
E86415Medicare UPIN
WV4145833Medicare PIN