Healthcare Provider Details

I. General information

NPI: 1073169595
Provider Name (Legal Business Name): DUSTIN MICHAEL DEFRANCISIS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2019
Last Update Date: 08/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22681 ROUTE 68
CLARION PA
16214-4019
US

IV. Provider business mailing address

22681 ROUTE 68
CLARION PA
16214-4019
US

V. Phone/Fax

Practice location:
  • Phone: 814-227-1221
  • Fax:
Mailing address:
  • Phone: 814-227-1221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberOA004871
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: