| Doctor Name: | MR. BRIAN JOSEPH CORMIER |
| NPI Number: | 1407045586 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PA |
| License Number: | PA11588 |
| Business Practice Address: | 850 West California St. Escalon, CA - 953202120 |
| Business Phone Number: | 2098382278 |
| Business Fax Number: | 2098382513 |
| Mailing Address: | 6437 Kenneth Charles Ct, RIVERBANK |
| State: | CA |
| Postal Code: | 953672123 |
| Phone Number: | 2098696715 |
| Fax Number: | 2098382513 |
| NPI Enumeration Date: | 10/15/2007 |
| NPI Last Update Date: | 10/15/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | PA11588 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |