Provider Demographics
NPI:1699112557
Name:JOHN P BRIODY MD SC
Entity type:Organization
Organization Name:JOHN P BRIODY MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROP
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:BRIODY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:715-732-6911
Mailing Address - Street 1:3900 HALL AVE
Mailing Address - Street 2:SUITE H
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143-1062
Mailing Address - Country:US
Mailing Address - Phone:715-732-6911
Mailing Address - Fax:
Practice Address - Street 1:3900 HALL AVE
Practice Address - Street 2:SUITE H
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-1062
Practice Address - Country:US
Practice Address - Phone:715-732-6911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-31
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty