Provider Demographics
NPI:1285665703
Name:KATZ, JEFFREY A (PA)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:A
Last Name:KATZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1668 N C HIGHWAY 16 SOUTH
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28681
Mailing Address - Country:US
Mailing Address - Phone:828-632-9736
Mailing Address - Fax:828-632-9544
Practice Address - Street 1:1668 N C HIGHWAY 16 SOUTH
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28681
Practice Address - Country:US
Practice Address - Phone:828-632-9736
Practice Address - Fax:828-632-9544
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC100418363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC970019668OtherRAILROAD MEDICARE
NCR34505Medicare UPIN
NC2744674Medicare ID - Type Unspecified