Healthcare Provider Details

I. General information

NPI: 1265692214
Provider Name (Legal Business Name): ELDOR BRISH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 W WILLIAM CANNON DR STE 401
AUSTIN TX
78745-5278
US

IV. Provider business mailing address

1500 CITYWEST BLVD STE 300
HOUSTON TX
77042-2549
US

V. Phone/Fax

Practice location:
  • Phone: 512-416-7246
  • Fax: 512-275-2833
Mailing address:
  • Phone: 713-620-4000
  • Fax: 713-458-4229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberN5593
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberN5593
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: