Provider Demographics
NPI:1639153109
Name:CALDERON, DAN RAYMOND (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DAN
Middle Name:RAYMOND
Last Name:CALDERON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:DAN
Other - Middle Name:RAYMOND
Other - Last Name:CALDERON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:5955 ZEAMER AVENUE
Mailing Address - Street 2:ELMENDORF AFB
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99506-2011
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5955 ZEAMER AVENUE
Practice Address - Street 2:ELMENDORF AFB
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99506-2011
Practice Address - Country:US
Practice Address - Phone:907-580-2322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1047311363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant