Provider Demographics
NPI:1285846311
Name:PITCAN, CLYDE JUNIOR (PA-C, MPAS)
Entity Type:Individual
Prefix:MR
First Name:CLYDE
Middle Name:JUNIOR
Last Name:PITCAN
Suffix:
Gender:M
Credentials:PA-C, MPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5385 RED LEAF CT
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-5019
Mailing Address - Country:US
Mailing Address - Phone:954-630-1114
Mailing Address - Fax:954-630-1155
Practice Address - Street 1:2401 E STREET NW
Practice Address - Street 2:SA-1 (OFFICE OF MEDICAL SERVICES U.S. DEPT OF STATE)
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20522-0001
Practice Address - Country:US
Practice Address - Phone:954-630-1114
Practice Address - Fax:954-630-1155
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9101860363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant