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General NPI Number Information
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NPI Number | 1902132335
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Entity Type | Individual
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Provider Name | GARY BRANDON HIGHTOWER PA-C
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Gender | Male
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Dates
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Enumeration Date | 10/20/2009
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Last Update Date | 10/31/2024
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Provider Practice Location Address
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Address Line | 1201 BROAD ROCK BLVD
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City | RICHMOND
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State | VA
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Zip | 23249-2163
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Country | US
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Telephone | 804-675-5000
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Fax | 804-675-5723
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Provider Business Mailing Address
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Address Line | 1201 BROAD ROCK BLVD
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City | RICHMOND
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State | VA
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Zip | 23249
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Country | US
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Telephone | 804-675-5000
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Fax | 804-755-7236
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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 | 0110 003103
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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