Provider Demographics
NPI:1477612372
Name:DRISKILL, BRENT R (MD)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:R
Last Name:DRISKILL
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 1:1800 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-6701
Mailing Address - Country:US
Mailing Address - Phone:202-870-2090
Mailing Address - Fax:
Practice Address - Street 1:3901 S ATHERTON ST STE 6
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-8324
Practice Address - Country:US
Practice Address - Phone:814-466-6396
Practice Address - Fax:814-466-6056
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC146197207Y00000X
IL036142067207Y00000X
VA0101240491207Y00000X
PAMD485648207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology