MEDICARE: MR. BRIAN D DEMIO PHYSICIAN ASSISTANT

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
1	363AM0700X	Medical Physician Assistant

General Provider Information

NPI Number	:	1902883523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRIAN D DEMIO PHYSICIAN ASSISTANT

Provider Business Mailing Address
First Line	:	PO BOX 195002
Second Line	:
City	:	KODIAK
State	:	AK
Zip	:	99619-5002
Country	:	US
Telephone Number	:	907-487-5757
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 ALBATROSS AVE
Second Line	:	COMMANDING OFFICER
City	:	KODIAK
State	:	AK
Zip	:	99615-6806
Country	:	US
Telephone Number	:	907-487-5757
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/23/2005
Last Update Date	:	07/08/2007

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