MEDICARE: STEPHEN TREVOR BRISCOE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	33339	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679568661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN TREVOR BRISCOE MD

Provider Business Mailing Address
First Line	:	1470 CUMBERLAND FALLS HWY
Second Line	:
City	:	CORBIN
State	:	KY
Zip	:	40701-2721
Country	:	US
Telephone Number	:	606-526-0433
Fax Number	:	606-526-0434

Provider Business Practice Location Address
First Line	:	1490 CUMBERLAND FALLS HWY
Second Line	:
City	:	CORBIN
State	:	KY
Zip	:	40701-2721
Country	:	US
Telephone Number	:	606-526-0433
Fax Number	:	606-526-0434

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	10/28/2020

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