Provider Demographics
NPI:1831366210
Name:DURZO, JAIME (PA-C)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:DURZO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JAIME
Other - Middle Name:
Other - Last Name:KEENAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:11279 PERRY HWY STE 108
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-9303
Mailing Address - Country:US
Mailing Address - Phone:724-933-9190
Mailing Address - Fax:724-933-9194
Practice Address - Street 1:11279 PERRY HWY
Practice Address - Street 2:SUITE 108
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-9381
Practice Address - Country:US
Practice Address - Phone:724-933-9190
Practice Address - Fax:724-933-9194
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053173363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant