Provider Demographics
NPI:1285618017
Name:VERCHER, JEFFREY T (PA C)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:T
Last Name:VERCHER
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8039 WASHINGTON VILLAGE DRIVE
Mailing Address - Street 2:STE 100
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45458-3859
Mailing Address - Country:US
Mailing Address - Phone:937-435-8999
Mailing Address - Fax:937-435-4211
Practice Address - Street 1:8039 WASHINGTON VILLAGE DRIVE
Practice Address - Street 2:STE 100
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45458
Practice Address - Country:US
Practice Address - Phone:937-435-8999
Practice Address - Fax:937-435-4211
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50002060363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0893476Medicaid
OH9289196Medicare PIN
OH0893476Medicaid
OH9289194Medicare PIN
OH9289195Medicare PIN