Individual
BRYAN RAFFERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
88MDG/SGGP, 4881 SUGAR MAPLE DR, WPAFB, OH 45433
(937) 713-9011
Mailing address
88MDG/SGGP, 4881 SUGAR MAPLE DR, WPAFB, OH 45433
(937) 713-9011
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2881
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q019535
—
TN
Enumeration date
10/21/2015
Last updated
06/17/2022
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