Basic Information
| Provider Information | |||||||||
| NPI: | 1851697965 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRIGGS | ||||||||
| FirstName: | DOUGLAS | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4201 LAKE BOONE TRL | ||||||||
| Address2: | STE 5 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276077511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724435300 | ||||||||
| FaxNumber: | 9724320498 | ||||||||
| Practice Location | |||||||||
| Address1: | 4201 LAKE BOONE TRL | ||||||||
| Address2: | STE 5 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9842228000 | ||||||||
| FaxNumber: | 9842228001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2011 | ||||||||
| LastUpdateDate: | 09/07/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | H4188 | TX | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 2018-00828 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.