Individual
DR. THEODORE EDWARD BRISSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2890 TRICOM STREET, NORTH CHARLESTON, SC 29406-9171
(843) 797-6600
(843) 820-1440
Mailing address
2890 TRICOM STREET, NORTH CHARLESTON, SC 29406-9171
(843) 797-6600
(843) 820-1440
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
30581
SC
208800000X
Urology Physician
ME90953
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7026
MEDICARE GROUP
SC
05
—
GP4871
—
SC
Enumeration date
12/02/2005
Last updated
04/17/2014
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