Provider Demographics
NPI:1902838808
Name:BRIGGS, DUSTIN JAMES (ATC)
Entity Type:Individual
Prefix:MR
First Name:DUSTIN
Middle Name:JAMES
Last Name:BRIGGS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 345
Mailing Address - Street 2:
Mailing Address - City:NEW SHARON
Mailing Address - State:IA
Mailing Address - Zip Code:50207-0345
Mailing Address - Country:US
Mailing Address - Phone:641-780-8836
Mailing Address - Fax:
Practice Address - Street 1:812 UNIVERSITY ST
Practice Address - Street 2:CAMPUS BOX 6600
Practice Address - City:PELLA
Practice Address - State:IA
Practice Address - Zip Code:50219-1902
Practice Address - Country:US
Practice Address - Phone:641-628-5328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA005292255A2300X
IAAEMT-11-1000-09146M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, Intermediate