Provider Demographics
NPI:1487612636
Name:SHEIDLER, JEB OWEN (PA-C)
Entity type:Individual
Prefix:MR
First Name:JEB
Middle Name:OWEN
Last Name:SHEIDLER
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:951 COMMERCE PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45804-4040
Mailing Address - Country:US
Mailing Address - Phone:419-998-4575
Mailing Address - Fax:419-998-4586
Practice Address - Street 1:1001 BELLEFONTAINE AVE
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-2800
Practice Address - Country:US
Practice Address - Phone:419-998-4575
Practice Address - Fax:419-998-4586
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2014-11-26
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000322918OtherANTHEM
OH000000322918OtherANTHEM
OHS63141Medicare UPIN