Provider Demographics
NPI:1265853386
Name:BRISON, CHARLES WESLEY JR (LRTT)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:WESLEY
Last Name:BRISON
Suffix:JR
Gender:M
Credentials:LRTT
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Mailing Address - Street 1:5745 PLAUCHE CT
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HARAHAN
Mailing Address - State:LA
Mailing Address - Zip Code:70123-4119
Mailing Address - Country:US
Mailing Address - Phone:504-734-0334
Mailing Address - Fax:504-733-0559
Practice Address - Street 1:5745 PLAUCHE CT
Practice Address - Street 2:SUITE 2
Practice Address - City:HARAHAN
Practice Address - State:LA
Practice Address - Zip Code:70123-4119
Practice Address - Country:US
Practice Address - Phone:504-734-0334
Practice Address - Fax:504-733-0559
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-16
Last Update Date:2013-12-16
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Provider Licenses
StateLicense IDTaxonomies
LALT2721332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies