Provider Demographics
NPI:1508884594
Name:RIMER, JOHN CHARLES (PA-C)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:CHARLES
Last Name:RIMER
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 1:1202 E NICOLET AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-5119
Mailing Address - Country:US
Mailing Address - Phone:602-679-3902
Mailing Address - Fax:
Practice Address - Street 1:9250 N 3RD ST STE 3025
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-2428
Practice Address - Country:US
Practice Address - Phone:602-944-4628
Practice Address - Fax:602-944-2805
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2524363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP49134Medicare UPIN