Provider Demographics
NPI:1073247524
Name:BEZAS, PAUL MICHAEL (PA-C)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:MICHAEL
Last Name:BEZAS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 TOWN CENTER DR STE 120
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718-5521
Mailing Address - Country:US
Mailing Address - Phone:307-682-9962
Mailing Address - Fax:307-257-2930
Practice Address - Street 1:51 TOWN CENTER DR STE 120
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-5521
Practice Address - Country:US
Practice Address - Phone:307-271-6477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-11
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WYPA1039363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program