Provider Demographics
NPI:1669826392
Name:PAMER, JEREMIAH LAWRENCE
Entity Type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:LAWRENCE
Last Name:PAMER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7345 164TH AVE NE STE I105
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-7857
Mailing Address - Country:US
Mailing Address - Phone:425-522-8312
Mailing Address - Fax:
Practice Address - Street 1:7345 164TH AVE NE STE I105
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-7857
Practice Address - Country:US
Practice Address - Phone:425-522-8312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-19
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP61023173207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine