Provider Demographics
NPI:1801806443
Name:VALDEZ, BRICCIO DIZON (MD)
Entity type:Individual
Prefix:DR
First Name:BRICCIO
Middle Name:DIZON
Last Name:VALDEZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6210 FLAT ROCK RD
Mailing Address - Street 2:APT. 6148 - B
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31907-9212
Mailing Address - Country:US
Mailing Address - Phone:706-568-5000
Mailing Address - Fax:
Practice Address - Street 1:3000 SCHATULGA RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-3117
Practice Address - Country:US
Practice Address - Phone:706-568-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0193532084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA019353OtherSTATE OF GA LICENSE