Healthcare Provider Details

I. General information

NPI: 1457811663
Provider Name (Legal Business Name): MICHAEL PAUL BRISSON DO, PHD, MPH, FAWM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2019
Last Update Date: 07/03/2022
Certification Date: 07/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 E MORRIS ST
SAMSON AL
36477-1229
US

IV. Provider business mailing address

98 E MORRIS ST
SAMSON AL
36477-1229
US

V. Phone/Fax

Practice location:
  • Phone: 334-898-2728
  • Fax:
Mailing address:
  • Phone: 334-898-2728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO2323
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS17202
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: