Individual
JEFFREY L BRAYSHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1501 OAKDALE RD, SUITE 218, MODESTO, CA 95355-3381
(209) 572-4222
Mailing address
600 COFFEE RD, MODESTO, CA 95355-4201
(209) 521-6097
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA17131
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA17131
PHYSICIAN ASSISTANT
CA
Enumeration date
10/25/2006
Last updated
05/26/2010
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