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General NPI Number Information
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NPI Number | 1598741860
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Entity Type | Individual
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Provider Name | BRYAN LEE CANWELL PA-C
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Gender | Male
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Dates
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Enumeration Date | 12/19/2005
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Last Update Date | 08/12/2020
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Provider Practice Location Address
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Address Line | 46314 TIMINE WAY
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City | PENDLETON
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State | OR
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Zip | 97801
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Country | US
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Telephone | 541-966-9830
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Fax | 541-240-8751
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Provider Business Mailing Address
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Address Line | P.O. BOX 160
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City | PENDLETON
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State | OR
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Zip | 97801
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Country | US
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Telephone | 541-966-9830
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Fax | 509-826-3653
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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 | PA157064
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License Number State | OR
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