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General NPI Number Information
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NPI Number | 1285846311
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Entity Type | Individual
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Provider Name | CLYDE JUNIOR PITCAN PA-C, MPAS
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Gender | Male
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2401 E STREET NW SA-1 (OFFICE OF MEDICAL SERVICES U.S. DEPT OF STATE)
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City | WASHINGTON
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State | DC
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Zip | 20522-0001
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Country | US
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Telephone | 954-630-1114
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Fax | 954-630-1155
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Provider Business Mailing Address
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Address Line | 5385 RED LEAF CT
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City | OVIEDO
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State | FL
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Zip | 32765-5019
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Country | US
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Telephone | 954-630-1114
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Fax | 954-630-1155
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9101860
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License Number State | FL
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