Healthcare Provider Details

I. General information

NPI: 1154722692
Provider Name (Legal Business Name): BRANDON JEFFREY PARSONS PA-CERTIFIED
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2014
Last Update Date: 11/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 SE POWELL VALLEY RD
GRESHAM OR
97080-1494
US

IV. Provider business mailing address

75-170 HUALALAI RD SUITE #C-110
KAILUA KONA HI
96740-1779
US

V. Phone/Fax

Practice location:
  • Phone: 503-666-5050
  • Fax: 503-666-1162
Mailing address:
  • Phone: 808-329-9211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberAMD661
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60996895
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: