Provider Demographics
NPI:1013772094
Name:BAZE, CONNOR DAWSON (PA-C)
Entity type:Individual
Prefix:
First Name:CONNOR
Middle Name:DAWSON
Last Name:BAZE
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:CONNOR
Other - Middle Name:DAWSON
Other - Last Name:CIEMIEWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2975 E BROAD ST STE 200
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-9186
Mailing Address - Country:US
Mailing Address - Phone:682-518-8619
Mailing Address - Fax:682-518-8195
Practice Address - Street 1:2975 E BROAD ST STE 200
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-9186
Practice Address - Country:US
Practice Address - Phone:682-518-8619
Practice Address - Fax:682-518-8195
Is Sole Proprietor?:No
Enumeration Date:2024-02-19
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA17881363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant