Individual
THOMAS DALE BRIESKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
815 SW BOND ST, BEND, OR 97702-3593
(541) 382-4900
Mailing address
PO BOX 6048, BEND, OR 97708-6048
(541) 382-4900
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA218471
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500830812
—
OR
Enumeration date
08/18/2022
Last updated
04/04/2025
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