Provider Demographics
NPI:1780993782
Name:STOWE, BRYAN DANIEL (PA-C)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:DANIEL
Last Name:STOWE
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 1:1449 LAS ENCINAS DR
Mailing Address - Street 2:
Mailing Address - City:LOS OSOS
Mailing Address - State:CA
Mailing Address - Zip Code:93402-4501
Mailing Address - Country:US
Mailing Address - Phone:208-241-2231
Mailing Address - Fax:
Practice Address - Street 1:320 SOLANO ST STE A
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:CA
Practice Address - Zip Code:96021-3454
Practice Address - Country:US
Practice Address - Phone:530-824-3283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-25
Last Update Date:2010-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 20995363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical