Provider Demographics
NPI:1245296144
Name:MERCHAN, JOE ALEX (PA-C)
Entity type:Individual
Prefix:
First Name:JOE
Middle Name:ALEX
Last Name:MERCHAN
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 1:6250 LONETREE BLVD # 2009
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-3790
Mailing Address - Country:US
Mailing Address - Phone:925-600-0193
Mailing Address - Fax:
Practice Address - Street 1:6250 LONETREE BLVD # 2009
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-3790
Practice Address - Country:US
Practice Address - Phone:925-600-0193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20405363AS0400X, 363AS0400X
WAPA60142888363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0262062OtherSTATE L&I
WA0261997OtherSTATE L&I
WA0261997OtherSTATE L&I