Provider Demographics
NPI:1245203132
Name:DREIS, PATRICK ARTHUR (PA)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:ARTHUR
Last Name:DREIS
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 1:451 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BIG STONE CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57216
Mailing Address - Country:US
Mailing Address - Phone:605-862-7999
Mailing Address - Fax:605-862-7998
Practice Address - Street 1:451 MAIN ST
Practice Address - Street 2:
Practice Address - City:BIG STONE CITY
Practice Address - State:SD
Practice Address - Zip Code:57216
Practice Address - Country:US
Practice Address - Phone:605-862-7999
Practice Address - Fax:605-862-7998
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0568363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0568OtherPA
SD6825640Medicaid
SD6825640Medicaid
SD0568OtherPA
Q04708Medicare UPIN