Provider Demographics
NPI:1902883523
Name:DEMIO, BRIAN D (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:D
Last Name:DEMIO
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 195002
Mailing Address - Street 2:
Mailing Address - City:KODIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99619-5002
Mailing Address - Country:US
Mailing Address - Phone:907-487-5757
Mailing Address - Fax:
Practice Address - Street 1:200 ALBATROSS AVE
Practice Address - Street 2:COMMANDING OFFICER
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99615-6806
Practice Address - Country:US
Practice Address - Phone:907-487-5757
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical