Provider Demographics
NPI:1801823372
Name:ALLSHOUSE, BRIAN S (PA-C)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:S
Last Name:ALLSHOUSE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10880
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86304-0880
Mailing Address - Country:US
Mailing Address - Phone:928-759-5987
Mailing Address - Fax:928-458-2039
Practice Address - Street 1:811 AINSWORTH DR
Practice Address - Street 2:SUITE 109
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1687
Practice Address - Country:US
Practice Address - Phone:928-771-5595
Practice Address - Fax:928-771-5596
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ1951363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ374009Medicaid
AZZ79839Medicare PIN
AZZ62063Medicare PIN
AZ374009Medicaid