Individual
DAVE A CANTRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2111 EXCHANGE ST, ASTORIA, OR 97103-3329
(503) 338-4087
Mailing address
2111 EXCHANGE ST, ASTORIA, OR 97103-3329
(503) 338-4087
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA10004576
WA
363A00000X
Physician Assistant
Primary
PA213112
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0279439
LABOR AND INDUSTRY
WA
05
—
1427005479
—
WA
05
—
7101132
—
WA
05
—
7117450
—
WA
05
—
806756200
—
ID
01
—
CJ6525
MEDICARE RAILROAD
WA
Enumeration date
05/27/2006
Last updated
11/03/2022
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