Provider Demographics
NPI:1427059179
Name:SCHWERDTFEGER, JEFFERY S (PA-C)
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:S
Last Name:SCHWERDTFEGER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:SCOTT
Other - Middle Name:
Other - Last Name:SCHWERDTFEGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:580-548-1367
Mailing Address - Fax:580-548-1583
Practice Address - Street 1:1084 NICKERSON ST
Practice Address - Street 2:
Practice Address - City:WAYNOKA
Practice Address - State:OK
Practice Address - Zip Code:73860-1245
Practice Address - Country:US
Practice Address - Phone:580-824-2291
Practice Address - Fax:580-824-0429
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPA396363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100848070AMedicaid
OKP00060438Medicare PIN
OK248328602Medicare ID - Type Unspecified
OK100848070AMedicaid