Provider Demographics
NPI:1679175749
Name:DUMAYAS, ETHAN ROSS YAP (PA-C)
Entity Type:Individual
Prefix:
First Name:ETHAN ROSS
Middle Name:YAP
Last Name:DUMAYAS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:ETHAN
Other - Middle Name:YAP
Other - Last Name:DUMAYAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:247 SHEKOMEKO LN
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-2938
Mailing Address - Country:US
Mailing Address - Phone:814-248-6252
Mailing Address - Fax:
Practice Address - Street 1:247 SHEKOMEKO LN
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-2938
Practice Address - Country:US
Practice Address - Phone:814-248-6252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA062011363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant