Healthcare Provider Details

I. General information

NPI: 1649431099
Provider Name (Legal Business Name): PAUL BRATCHER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2008
Last Update Date: 07/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13065 W MCDOWELL RD STE A105
AVONDALE AZ
85392
US

IV. Provider business mailing address

13065 W MCDOWELL RD STE A105
AVONDALE AZ
85392-6440
US

V. Phone/Fax

Practice location:
  • Phone: 623-536-6788
  • Fax: 623-536-9288
Mailing address:
  • Phone: 623-536-6788
  • Fax: 623-536-9288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2320
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: