Provider Demographics
NPI:1689914145
Name:SCHLEIBAUM, JEREMY JOHN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:JOHN
Last Name:SCHLEIBAUM
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 1:15425 N GREENWAY HAYDEN LOOP STE A-300
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-1204
Mailing Address - Country:US
Mailing Address - Phone:480-607-1124
Mailing Address - Fax:
Practice Address - Street 1:15425 N GREENWAY HAYDEN LOOP STE A-300
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-1204
Practice Address - Country:US
Practice Address - Phone:480-607-1124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-20
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5354363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant