Healthcare Provider Details

I. General information

NPI: 1285814129
Provider Name (Legal Business Name): JOEL M DEMING PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2007
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 COOKS HILL RD
CENTRALIA WA
98531-9071
US

IV. Provider business mailing address

1793 13TH ST SE
SALEM OR
97302-2541
US

V. Phone/Fax

Practice location:
  • Phone: 503-362-8385
  • Fax: 503-362-8435
Mailing address:
  • Phone: 503-362-8385
  • Fax: 503-362-8435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA10005313
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: