Provider Demographics
NPI:1811568058
Name:GRATZER, JACOB R (PA)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:R
Last Name:GRATZER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8638 GRAHAM CIR
Mailing Address - Street 2:
Mailing Address - City:OLMSTED FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44138-2352
Mailing Address - Country:US
Mailing Address - Phone:440-897-8870
Mailing Address - Fax:
Practice Address - Street 1:8638 GRAHAM CIR
Practice Address - Street 2:
Practice Address - City:OLMSTED FALLS
Practice Address - State:OH
Practice Address - Zip Code:44138-2352
Practice Address - Country:US
Practice Address - Phone:440-897-8870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.007032RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant