Individual
MR. BRIAN MATEO ENRIQUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
24530 FALCON PLACE BLVD, SUITE 100, ABINGDON, VA 24211
(276) 619-0075
(276) 619-0077
Mailing address
509 MED TECH PKWY STE 100, JOHNSON CITY, TN 37604-2579
(423) 302-6565
(423) 952-2175
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0102203391
VA
207Q00000X
Family Medicine Physician
1599
HI
207Q00000X
Family Medicine Physician
2691
TN
208M00000X
Hospitalist Physician
0102203391
VA
208M00000X
Hospitalist Physician
2681
TN
Other
Enumeration date
09/04/2008
Last updated
07/20/2018
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