Provider Demographics
NPI:1346505732
Name:LOVING, JEREMY (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:
Last Name:LOVING
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 1:825 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:LEADVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80461-2205
Mailing Address - Country:US
Mailing Address - Phone:719-486-1264
Mailing Address - Fax:719-486-1286
Practice Address - Street 1:825 W 6TH ST
Practice Address - Street 2:
Practice Address - City:LEADVILLE
Practice Address - State:CO
Practice Address - Zip Code:80461-2205
Practice Address - Country:US
Practice Address - Phone:719-486-1264
Practice Address - Fax:719-486-1286
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0004477363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical