Healthcare Provider Details

I. General information

NPI: 1992796189
Provider Name (Legal Business Name): THOMAS L BRISCOE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 07/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 S COLLEGE RD BLDG 5
LAFAYETTE LA
70503-2917
US

IV. Provider business mailing address

400 MILL POND DR
YOUNGSVILLE LA
70592-5668
US

V. Phone/Fax

Practice location:
  • Phone: 337-235-6886
  • Fax: 337-235-6892
Mailing address:
  • Phone: 337-241-9269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPST.015227
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberA10327
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberA10327.RX
License Number StateLA
# 4
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberA10327
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: