Provider Demographics
NPI:1861829665
Name:DEMAS, CLINT (PA-C)
Entity Type:Individual
Prefix:
First Name:CLINT
Middle Name:
Last Name:DEMAS
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 1:16035 W DESERT MIRAGE DR
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-4827
Mailing Address - Country:US
Mailing Address - Phone:435-862-2124
Mailing Address - Fax:
Practice Address - Street 1:5002 W GLENDALE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-2756
Practice Address - Country:US
Practice Address - Phone:623-847-5300
Practice Address - Fax:623-847-5304
Is Sole Proprietor?:No
Enumeration Date:2013-10-11
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5523363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical