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BRENT C DAWSON P.A.

Surgical >> Physician Assistant >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1548566276

Individual Registrant:
 BRENT C DAWSON P.A.
Gender: M
Not Sole Proprietor

Location and contact information for practice:
3304 RENNER DR  FORTUNA, CA 95540-7102 US
Tel: 707-725-9383  Fax: 707-725-1140

Contact information for business:
PO BOX 27128  SALT LAKE CITY, UT 84127-0128 US
Tel: 801-285-4650  Fax: 801-285-4651

Registration Information:
NPI: 1548566276
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
N363AS0400XPhysician Assistants & Advanced Practice Nursing Providers
Physician Assistant
Surgical
CAPA21433
Y363A00000XPhysician Assistants & Advanced Practice Nursing Providers
Physician Assistant
UT8289902-1206

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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