Basic Information
| Provider Information | |||||||||
| NPI: | 1952627663 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BROWER | ||||||||
| FirstName: | RYAN | ||||||||
| MiddleName: | WADE | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6402 E SUPERSTITION SPRINGS BLVD | ||||||||
| Address2: | STE 123 | ||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852064391 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4807941061 | ||||||||
| FaxNumber: | 4804945770 | ||||||||
| Practice Location | |||||||||
| Address1: | 6820 S KINGS RANCH RD | ||||||||
| Address2: | SUITE 130 | ||||||||
| City: | GOLD CANYON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 851182935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4809823691 | ||||||||
| FaxNumber: | 4809823692 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2010 | ||||||||
| LastUpdateDate: | 09/08/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.