Provider Demographics
NPI:1730313602
Name:SIGNAL, BRIAN W
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:W
Last Name:SIGNAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 CUTISS RD
Mailing Address - Street 2:2 MDG
Mailing Address - City:BARKSDALE AFB
Mailing Address - State:LA
Mailing Address - Zip Code:71110
Mailing Address - Country:US
Mailing Address - Phone:318-456-8576
Mailing Address - Fax:
Practice Address - Street 1:243 CUTISS RD
Practice Address - Street 2:2 MDG
Practice Address - City:BARKSDALE AFB
Practice Address - State:LA
Practice Address - Zip Code:71110
Practice Address - Country:US
Practice Address - Phone:318-456-8576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-07
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians