Provider Demographics
NPI:1699090407
Name:BROWN, DANIEL A (PA-C)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:A
Last Name:BROWN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 E NEWPORT AVE
Mailing Address - Street 2:
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-2449
Mailing Address - Country:US
Mailing Address - Phone:541-567-1137
Mailing Address - Fax:541-567-2336
Practice Address - Street 1:236 E NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-2449
Practice Address - Country:US
Practice Address - Phone:541-567-1137
Practice Address - Fax:541-567-2336
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-05
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA151128363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR080385000OtherBLUE CROSS BLUE SHIELD
OROR1807OtherHEALTH NET
OR223149Medicaid
OR080385000OtherBLUE CROSS BLUE SHIELD
OROR1807OtherHEALTH NET