Provider Demographics
NPI:1407045586
Name:CORMIER, BRIAN JOSEPH (PA)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:JOSEPH
Last Name:CORMIER
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:6437 KENNETH CHARLES CT
Mailing Address - Street 2:
Mailing Address - City:RIVERBANK
Mailing Address - State:CA
Mailing Address - Zip Code:95367-2123
Mailing Address - Country:US
Mailing Address - Phone:209-869-6715
Mailing Address - Fax:209-838-2513
Practice Address - Street 1:850 WEST CALIFORNIA ST.
Practice Address - Street 2:
Practice Address - City:ESCALON
Practice Address - State:CA
Practice Address - Zip Code:95320-2120
Practice Address - Country:US
Practice Address - Phone:209-838-2278
Practice Address - Fax:209-838-2513
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-15
Last Update Date:2007-10-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPA11588363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical