Provider Demographics
NPI:1174828487
Name:SHOWALTER, BRIAN PAUL (PA-C)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:PAUL
Last Name:SHOWALTER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:416 COLEGATE DR BLDG 3
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-9549
Mailing Address - Country:US
Mailing Address - Phone:740-568-4814
Mailing Address - Fax:740-374-3165
Practice Address - Street 1:400 MATTHEW ST STE 101
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-1656
Practice Address - Country:US
Practice Address - Phone:740-568-4150
Practice Address - Fax:740-568-4151
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-18
Last Update Date:2022-02-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WV01536363AS0400X
OH50.003230RX363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical