MEDICARE: REBEKAH GRACE BRISCOE DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	02002770A	IN
2	207Q00000X	Family Medicine Physician	183279	AK

General Provider Information

NPI Number	:	1861481210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBEKAH GRACE BRISCOE DO

Provider Business Mailing Address
First Line	:	4320 DIPLOMACY DR STE 2191
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-5925
Country	:	US
Telephone Number	:	907-729-3300
Fax Number	:

Provider Business Practice Location Address
First Line	:	4320 DIPLOMACY DR STE 2191
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-5925
Country	:	US
Telephone Number	:	907-729-3300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2005
Last Update Date	:	09/30/2022

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