Provider Demographics
NPI:1326565136
Name:MOTIS, DAXSON (PA-C)
Entity Type:Individual
Prefix:
First Name:DAXSON
Middle Name:
Last Name:MOTIS
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 1:16420 SE MCGILLIVRAY BLVD STE 103-253
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-3461
Mailing Address - Country:US
Mailing Address - Phone:360-831-2276
Mailing Address - Fax:
Practice Address - Street 1:1499 SE TECH CENTER PL STE 190
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-5529
Practice Address - Country:US
Practice Address - Phone:425-507-7848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-23
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA184998363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant