Healthcare Provider Details

I. General information

NPI: 1518792167
Provider Name (Legal Business Name): AUSTIN DRAGO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2024
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629TH MCAS UNIT #15342
APO AP
96224
US

IV. Provider business mailing address

1550 STACKHOUSE DR
FAYETTEVILLE NC
28314-6355
US

V. Phone/Fax

Practice location:
  • Phone: 910-689-7126
  • Fax:
Mailing address:
  • Phone: 910-689-7126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1246096
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: