MEDICARE: RUSSELL DEANE BRIGGS M.D.

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	207YX0905X	Otolaryngology/Facial Plastic Surgery Physician	M3931	TX

General Provider Information

NPI Number	:	1942245196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUSSELL DEANE BRIGGS M.D.

Provider Business Mailing Address
First Line	:	2765 BEE CAVE RD
Second Line	:	SUITE 205
City	:	AUSTIN
State	:	TX
Zip	:	78746-5640
Country	:	US
Telephone Number	:	512-328-7722
Fax Number	:	512-328-7724

Provider Business Practice Location Address
First Line	:	2765 BEE CAVE RD
Second Line	:	SUITE 205
City	:	AUSTIN
State	:	TX
Zip	:	78746-5640
Country	:	US
Telephone Number	:	512-328-7722
Fax Number	:	512-328-7724

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

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	10/30/2014

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