Provider Demographics
NPI:1265614069
Name:SAWYERS, JERAMY D (PA)
Entity type:Individual
Prefix:
First Name:JERAMY
Middle Name:D
Last Name:SAWYERS
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:PSC 561 BOX 157
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96310-0002
Mailing Address - Country:US
Mailing Address - Phone:619-606-1250
Mailing Address - Fax:
Practice Address - Street 1:MARINE CORPS AIR STATION IWAKUNI, JAPAN
Practice Address - Street 2:BRANCH HEALTH CLINIC
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96310
Practice Address - Country:US
Practice Address - Phone:315-255-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2019-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171000000X
1161404363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No171000000XOther Service ProvidersMilitary Health Care Provider