Individual
ALAN GAGNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
0110003260
VA
363AS0400X
Surgical Physician Assistant
0284P
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C06778
GROUP PTAN
VA
Enumeration date
06/27/2008
Last updated
07/19/2010
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