Provider Demographics
NPI:1417288275
Name:DESPAS, FRANTZ FORBES JR (PA-C)
Entity Type:Individual
Prefix:MR
First Name:FRANTZ
Middle Name:FORBES
Last Name:DESPAS
Suffix:JR
Gender:M
Credentials:PA-C
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Other - First Name:
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Mailing Address - Street 1:400 N MOUNTAIN AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-5176
Mailing Address - Country:US
Mailing Address - Phone:909-920-0876
Mailing Address - Fax:909-946-4926
Practice Address - Street 1:400 N MOUNTAIN AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-5176
Practice Address - Country:US
Practice Address - Phone:909-920-0876
Practice Address - Fax:909-946-4926
Is Sole Proprietor?:No
Enumeration Date:2010-01-19
Last Update Date:2015-04-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPA20636363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical