Provider Demographics
NPI:1154863173
Name:FRANCOM, CHAD (PA-C)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:FRANCOM
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 1:3325 RESEARCH WAY
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706-7913
Mailing Address - Country:US
Mailing Address - Phone:775-888-6610
Mailing Address - Fax:775-888-4904
Practice Address - Street 1:925 WELLS AVENUE
Practice Address - Street 2:
Practice Address - City:W. WENDOVER
Practice Address - State:NV
Practice Address - Zip Code:89883-3520
Practice Address - Country:US
Practice Address - Phone:775-664-2220
Practice Address - Fax:775-664-2965
Is Sole Proprietor?:No
Enumeration Date:2016-11-08
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA1784363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVPA1784OtherNEVADA PA LICENSE