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NPI Code Detail

MEDICARE: CHAD GAGNON PA-C

MEDICARE: CHAD GAGNON PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician AssistantPA10396CA

General Provider Information

NPI Number : 1568460665
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHAD GAGNON PA-C
Provider Business Mailing Address
First Line : 501 N INDIAN RD
Second Line :
City : SMITH RIVER
State : CA
Zip : 95567-9509
Country : US
Telephone Number : 707-487-0215
Fax Number : 707-487-1304
Provider Business Practice Location Address
First Line : 501 N INDIAN RD
Second Line :
City : SMITH RIVER
State : CA
Zip : 95567-9509
Country : US
Telephone Number : 707-487-0215
Fax Number : 707-487-1304
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2005
Last Update Date : 07/16/2007

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Directions to “ CHAD GAGNON PA-C” Practice Location

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