Provider Demographics
NPI:1811221211
Name:BRIESE, BEAU (MD)
Entity Type:Individual
Prefix:DR
First Name:BEAU
Middle Name:
Last Name:BRIESE
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 1:2455 DUNSTAN RD
Mailing Address - Street 2:SUITE 281
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005-2537
Mailing Address - Country:US
Mailing Address - Phone:310-890-7604
Mailing Address - Fax:
Practice Address - Street 1:2455 DUNSTAN RD
Practice Address - Street 2:SUITE 281
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005-2537
Practice Address - Country:US
Practice Address - Phone:310-890-7604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-01
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA115999207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine