Provider Demographics
NPI:1457320111
Name:WASHBURN, DANIEL G (PA C)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:G
Last Name:WASHBURN
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 1:927 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801
Mailing Address - Country:US
Mailing Address - Phone:256-539-2728
Mailing Address - Fax:256-428-3423
Practice Address - Street 1:927 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801
Practice Address - Country:US
Practice Address - Phone:256-539-2728
Practice Address - Fax:256-428-3423
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA170363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0910127OtherUNITED HEALTHCARE
AL51527849OtherBCBS
AL891009770Medicaid
AL891009770Medicaid
AL051527849Medicare ID - Type Unspecified