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Individual

MR. BRYAN LEE CANWELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
46314 TIMINE WAY, PENDLETON, OR 97801
(541) 966-9830
(541) 240-8751
Mailing address
P.O. BOX 160, PENDLETON, OR 97801
(541) 966-9830
(509) 826-3653

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA157064
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
500650388
OR
05
8370884
WA
01
8944528
L&I-CRIME VICTIM
WA
Enumeration date
12/19/2005
Last updated
08/12/2020
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