Provider Demographics
NPI:1134284292
Name:GAWTHROP, STEVEN CLARK (PA)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:CLARK
Last Name:GAWTHROP
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5730 CANYON VIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-5503
Mailing Address - Country:US
Mailing Address - Phone:530-872-2000
Mailing Address - Fax:530-876-3127
Practice Address - Street 1:5730 CANYON VIEW DRIVE
Practice Address - Street 2:
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-5534
Practice Address - Country:US
Practice Address - Phone:530-872-2000
Practice Address - Fax:530-876-3127
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 15074363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMG0913904OtherDEA#