Provider Demographics
NPI:1659314078
Name:PRICE, DENNIS R (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:R
Last Name:PRICE
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 1:611 W. PARK ST.
Mailing Address - Street 2:BWPC
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2500
Mailing Address - Country:US
Mailing Address - Phone:217-383-6792
Mailing Address - Fax:
Practice Address - Street 1:619 N. CHICAGO ST.
Practice Address - Street 2:
Practice Address - City:ROSSVILLE
Practice Address - State:IL
Practice Address - Zip Code:60963-0248
Practice Address - Country:US
Practice Address - Phone:217-748-4141
Practice Address - Fax:217-748-6973
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085000233363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
C37054Medicare UPIN