Provider Demographics
NPI:1184994402
Name:HERBERT, BRIAN MICHAEL (PA-C)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:MICHAEL
Last Name:HERBERT
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:1060 GAFFNEY RD STOP 7440
Mailing Address - Street 2:
Mailing Address - City:FORT WAINWRIGHT
Mailing Address - State:AK
Mailing Address - Zip Code:99703-5007
Mailing Address - Country:US
Mailing Address - Phone:907-361-5603
Mailing Address - Fax:907-361-4847
Practice Address - Street 1:1060 GAFFNEY RD STOP 7440
Practice Address - Street 2:
Practice Address - City:FORT WAINWRIGHT
Practice Address - State:AK
Practice Address - Zip Code:99703-5007
Practice Address - Country:US
Practice Address - Phone:907-361-5603
Practice Address - Fax:907-361-4847
Is Sole Proprietor?:No
Enumeration Date:2012-01-03
Last Update Date:2012-01-03
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant