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General NPI Number Information
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NPI Number | 1407045586
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Entity Type | Individual
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Provider Name | BRIAN JOSEPH CORMIER PA
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Gender | Male
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Dates
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Enumeration Date | 10/15/2007
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Last Update Date | 10/15/2007
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Provider Practice Location Address
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Address Line | 850 WEST CALIFORNIA ST.
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City | ESCALON
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State | CA
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Zip | 95320-2120
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Country | US
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Telephone | 209-838-2278
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Fax | 209-838-2513
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Provider Business Mailing Address
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Address Line | 6437 KENNETH CHARLES CT
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City | RIVERBANK
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State | CA
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Zip | 95367-2123
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Country | US
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Telephone | 209-869-6715
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Fax | 209-838-2513
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA11588
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License Number State | CA
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