Collaboration Agreement No:
9836
Confirmation No:
9836_5075C0008177
Section 1 - Physician Assistant Information
Confidential Information redacted.
Section 2 - Primary Practice Setting & Location:
Practice Type:
Urgent Care-Patient First
Facility
Patient First: UC in Bowie
Address
15459 Annapolis Road
Bowie
MD 20715
Is this the location where a copy of your collaboration agreement is on file? NO
A copy (paper or electronic) must be immediately available upon request by the Board.
Location: Patient First Admin Office, 5000 Cox Road, Glen Allen, VA 23060
Section 3 - Advanced Duties and Prescriptive and Dispensing Authority
1.Does this Collaboration Agreement include Advanced Duties?
NO
2. Does this Collaboration Agreement include prescriptive authority?
YES
3. Does this Collaboration Agreement include dispensing authority under a physician's active dispensing permit?
YES
Physician's Name: Dr. Jean Masoso | License No: D0081396