Provider Demographics
NPI:1972650729
Name:DEMIAR, OVIDIO BUSCAINO (PA-C)
Entity Type:Individual
Prefix:
First Name:OVIDIO
Middle Name:BUSCAINO
Last Name:DEMIAR
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:PO BOX 957
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:WA
Mailing Address - Zip Code:98944-0957
Mailing Address - Country:US
Mailing Address - Phone:509-839-6822
Mailing Address - Fax:509-839-5913
Practice Address - Street 1:700 S 11TH ST
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:WA
Practice Address - Zip Code:98944-2243
Practice Address - Country:US
Practice Address - Phone:509-839-6288
Practice Address - Fax:509-839-5913
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10001114363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0166737OtherLABOR & INDUSTRIES
WAPA10001114OtherSTATE LICENSE
WAG115140700OtherMEDICARE ID-PIN
WAG115140700OtherMEDICARE ID-PIN
WAG115140700Medicare PIN
WAPA10001114OtherSTATE LICENSE
WAMD0086985OtherDEA LICENSE