Provider Demographics
NPI:1710374038
Name:BRISCOE, MARSHALL ADAMS JR (MD)
Entity Type:Individual
Prefix:MR
First Name:MARSHALL
Middle Name:ADAMS
Last Name:BRISCOE
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 321359
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-1359
Mailing Address - Country:US
Mailing Address - Phone:601-936-1395
Mailing Address - Fax:601-933-6596
Practice Address - Street 1:1030 RIVER OAKS DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39232-9553
Practice Address - Country:US
Practice Address - Phone:601-376-2832
Practice Address - Fax:601-376-1816
Is Sole Proprietor?:No
Enumeration Date:2015-04-24
Last Update Date:2021-09-20
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Provider Licenses
StateLicense IDTaxonomies
MS25804207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06029871Medicaid
MS687536OtherINTERNAL MEDICINE