Provider Demographics
NPI:1285746057
Name:DECOMMER, PATRICK RAYMOND (PA-C)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:RAYMOND
Last Name:DECOMMER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6013
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95604-6013
Mailing Address - Country:US
Mailing Address - Phone:530-889-6300
Mailing Address - Fax:530-889-6303
Practice Address - Street 1:3227 PROFESSIONAL DR
Practice Address - Street 2:SUITE A
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95602-2414
Practice Address - Country:US
Practice Address - Phone:530-889-6300
Practice Address - Fax:530-889-6303
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA12317363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA12317OtherLICENSE
CAPA12317OtherLICENSE