# DR. THEODORE EDWARD BRISSON

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1699759563
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208800000X | Urology Physician | 30581 | SC | Yes |
| 208800000X | Urology Physician | ME90953 | FL | — |

## Other

- **Enumeration date:** 12/02/2005
- **Last updated:** 04/17/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 7026 | MEDICARE GROUP | SC |
| 05 | — | GP4871 | — | SC |