Provider Demographics
NPI:1750384897
Name:BRISCOE, DONALD ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:ANTHONY
Last Name:BRISCOE
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 1:4349 MARTIN LUTHER KING BLVD STE 1001E
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77204-0001
Mailing Address - Country:US
Mailing Address - Phone:713-743-9682
Mailing Address - Fax:713-743-1049
Practice Address - Street 1:4349 MARTIN LUTHER KING BLVD STE 1001E
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77204-3022
Practice Address - Country:US
Practice Address - Phone:713-743-9682
Practice Address - Fax:713-743-1049
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4265207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX142445902OtherTH STEPS
TX142445901Medicaid
TX158622401Medicaid
TX1750384897Medicaid
TXTRICAREOtherL4265
TX8G2488OtherBCNS
TXTRICAREOtherL4265
TX158622401Medicaid