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General NPI Number Information
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NPI Number | 1265853386
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Entity Type | Individual
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Provider Name | CHARLES WESLEY BRISON JR. LRTT
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Gender | Male
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Dates
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Enumeration Date | 12/16/2013
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Last Update Date | 12/16/2013
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Provider Practice Location Address
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Address Line | 5745 PLAUCHE CT SUITE 2
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City | HARAHAN
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State | LA
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Zip | 70123-4119
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Country | US
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Telephone | 504-734-0334
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Fax | 504-733-0559
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Provider Business Mailing Address
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Address Line | 5745 PLAUCHE CT SUITE 2
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City | HARAHAN
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State | LA
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Zip | 70123-4119
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Country | US
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Telephone | 504-734-0334
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Fax | 504-733-0559
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | LT2721
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License Number State | LA
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