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Individual
BRENT DEMANBY
Active
Individual
BRENT DEMANBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1180085
IL
363AS0400X
Surgical Physician Assistant
Primary
PA213402
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1180085
NCCPA
IL
01
—
156310
ARDMS
OR
Enumeration date
01/22/2021
Last updated
07/15/2025
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