Provider Demographics
NPI:1912045212
Name:BRISCOE, BRIAN T (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:T
Last Name:BRISCOE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2700 STANLEY GAULT PKWY STE 129
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5176
Mailing Address - Country:US
Mailing Address - Phone:502-253-4900
Mailing Address - Fax:502-489-5751
Practice Address - Street 1:401 E. CHESTNUT ST.
Practice Address - Street 2:STE 610
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202
Practice Address - Country:US
Practice Address - Phone:502-813-6600
Practice Address - Fax:502-813-6650
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY431982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP01458486OtherRR MEDICARE
KY7100107260Medicaid
KY3315711Medicare PIN
KYP01458486OtherRR MEDICARE
KYP400017039Medicare PIN
KYK000864Medicare PIN