Provider Demographics
NPI:1427335546
Name:ZIEGLER, JEREMY WAYNE (PA)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:WAYNE
Last Name:ZIEGLER
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 1:1030 W 24TH ST
Mailing Address - Street 2:SUITE H
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-8345
Mailing Address - Country:US
Mailing Address - Phone:928-344-4325
Mailing Address - Fax:928-344-3084
Practice Address - Street 1:1030 W 24TH ST
Practice Address - Street 2:SUITE H
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8345
Practice Address - Country:US
Practice Address - Phone:928-344-4325
Practice Address - Fax:928-344-3084
Is Sole Proprietor?:No
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5070363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant