Provider Demographics
NPI:1902581150
Name:MCALLEN, BRIAN THOMAS
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:THOMAS
Last Name:MCALLEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-9795
Mailing Address - Country:US
Mailing Address - Phone:805-286-6311
Mailing Address - Fax:
Practice Address - Street 1:2250 ORCHARD RD
Practice Address - Street 2:
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-9795
Practice Address - Country:US
Practice Address - Phone:805-286-6311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-15
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
CA63150363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant