Provider Demographics
NPI:1891737649
Name:CHANDLER, JEFFREY B (PA-C)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:B
Last Name:CHANDLER
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:PO BOX 6504
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59604-6504
Mailing Address - Country:US
Mailing Address - Phone:406-324-7003
Mailing Address - Fax:406-442-6322
Practice Address - Street 1:2910 PROSPECT AVE STE 2
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-9726
Practice Address - Country:US
Practice Address - Phone:406-324-7003
Practice Address - Fax:406-442-6322
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004617363A00000X
FLPA9103979363A00000X
MTMED-PAC-LIC-62036363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAQ56153Medicare UPIN