Provider Demographics
NPI:1841271913
Name:PITTS, DUANE ARNOLD (PA-C)
Entity type:Individual
Prefix:
First Name:DUANE
Middle Name:ARNOLD
Last Name:PITTS
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 1:1210 E ALMOND AVE
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93637-5606
Mailing Address - Country:US
Mailing Address - Phone:559-675-5530
Mailing Address - Fax:559-675-5433
Practice Address - Street 1:1210 E ALMOND AVE
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-5606
Practice Address - Country:US
Practice Address - Phone:559-675-5530
Practice Address - Fax:559-675-5433
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15680363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PA156801Medicare ID - Type Unspecified
P50803Medicare UPIN