Individual
MR. BRIAN R THEROUX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1672 S COUNTY TRL, STE 101, E GREENWICH, RI 02818-5098
(401) 885-7546
(401) 885-6658
Mailing address
1672 S COUNTY TRL, STE. 301, E GREENWICH, RI 02818-5098
(401) 885-7546
(401) 885-5465
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA00289
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DE76182
—
RI
Enumeration date
08/14/2006
Last updated
06/27/2012
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