Healthcare Provider Details

I. General information

NPI: 1780993782
Provider Name (Legal Business Name): BRYAN DANIEL STOWE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2010
Last Update Date: 09/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 SOLANO ST STE A
CORNING CA
96021-3454
US

IV. Provider business mailing address

1449 LAS ENCINAS DR
LOS OSOS CA
93402-4501
US

V. Phone/Fax

Practice location:
  • Phone: 530-824-3283
  • Fax:
Mailing address:
  • Phone: 208-241-2231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA 20995
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: