MEDICARE: NATHAN DENNIS PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	PA227559	OR
2	363A00000X	Physician Assistant	PA227559	OR

General Provider Information

NPI Number	:	1780563767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHAN DENNIS PA

Provider Business Mailing Address
First Line	:	3000 BRYANT WILLIAMS DR STE 110
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97601-1139
Country	:	US
Telephone Number	:	541-882-6311
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 BRYANT WILLIAMS DR STE 110
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97601-1139
Country	:	US
Telephone Number	:	541-274-8900
Fax Number	:	541-274-8908

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2025
Last Update Date	:	04/14/2026

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Directions to “ NATHAN DENNIS PA” Practice Location

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