Provider Demographics
NPI:1699093229
Name:SCHMIDT, JEFFREY MATTHEW (PA-C)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:MATTHEW
Last Name:SCHMIDT
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 1:575 KINCHELOE LOOP
Mailing Address - Street 2:PETERSON AFB
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80926
Mailing Address - Country:US
Mailing Address - Phone:719-554-9717
Mailing Address - Fax:
Practice Address - Street 1:575 KINCHELOE LOOP
Practice Address - Street 2:PETERSON AFB
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80926
Practice Address - Country:US
Practice Address - Phone:719-554-9717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-06
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0003541363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical