Provider Demographics
NPI:1437433521
Name:KUREC, BRYAN SCOTT (PA-C)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:SCOTT
Last Name:KUREC
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 1:18275 N 59TH AVENUE
Mailing Address - Street 2:BLDG K 162
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-1254
Mailing Address - Country:US
Mailing Address - Phone:602-547-8184
Mailing Address - Fax:602-547-8339
Practice Address - Street 1:18275 N 59TH AVENUE
Practice Address - Street 2:BLDG K 162
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1254
Practice Address - Country:US
Practice Address - Phone:602-547-8184
Practice Address - Fax:602-547-8339
Is Sole Proprietor?:No
Enumeration Date:2011-10-06
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5009363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5009OtherPA LIC
AZ164383Medicare PIN