Provider Demographics
NPI:1255356838
Name:ROWE, JEREMY D (PA-C)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:D
Last Name:ROWE
Suffix:
Gender:M
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:3280 DAUPHIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606-4060
Mailing Address - Country:US
Mailing Address - Phone:251-450-3700
Mailing Address - Fax:251-662-3819
Practice Address - Street 1:3280 DAUPHIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-4060
Practice Address - Country:US
Practice Address - Phone:251-450-3700
Practice Address - Fax:251-662-3819
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ALPA-447363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALQ58950Medicare UPIN