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General NPI Number Information
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NPI Number | 1992796189
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Entity Type | Individual
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Provider Name | THOMAS L BRISCOE PA-C
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Gender | Male
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Dates
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Enumeration Date | 11/04/2005
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Last Update Date | 07/10/2019
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Provider Practice Location Address
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Address Line | 1245 S COLLEGE RD BLDG 5
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City | LAFAYETTE
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State | LA
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Zip | 70503-2917
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Country | US
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Telephone | 337-235-6886
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Fax | 337-235-6892
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Provider Business Mailing Address
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Address Line | 400 MILL POND DR
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City | YOUNGSVILLE
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State | LA
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Zip | 70592-5668
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Country | US
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Telephone | 337-241-9269
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Fax |
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PST.015227
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | A10327
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License Number State | LA
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | A10327.RX
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License Number State | LA
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Taxonomy #4
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | A10327
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License Number State | LA
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