Provider Demographics
NPI:1700965753
Name:BRIONES, CARMEN CABAILO (MD)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:CABAILO
Last Name:BRIONES
Suffix:
Gender:F
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:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:218-333-5000
Mailing Address - Fax:218-333-5360
Practice Address - Street 1:615 NORTH F STREET
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520
Practice Address - Country:US
Practice Address - Phone:360-533-4599
Practice Address - Fax:360-537-6514
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN52752208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1700965753Medicaid
MN1700965753Medicaid