Provider Demographics
NPI:1245233105
Name:PRIGG, J BRIAN (PA-C,PHD)
Entity Type:Individual
Prefix:
First Name:J
Middle Name:BRIAN
Last Name:PRIGG
Suffix:
Gender:M
Credentials:PA-C,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16529 COASTAL HWY
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-3605
Mailing Address - Country:US
Mailing Address - Phone:302-684-2000
Mailing Address - Fax:302-644-6860
Practice Address - Street 1:16529 COASTAL HWY
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-3605
Practice Address - Country:US
Practice Address - Phone:302-684-2000
Practice Address - Fax:302-644-6860
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC50000284363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEG01368M02Medicare ID - Type UnspecifiedMEDICARE
S40766Medicare UPIN
DES40766Medicare UPIN