MEDICARE: JEFFERY S SCHWERDTFEGER PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA396	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427059179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFERY S SCHWERDTFEGER PA-C

Provider Business Mailing Address
First Line	:	5300 N INDEPENDENCE AVE
Second Line	:	280
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-5556
Country	:	US
Telephone Number	:	580-548-1367
Fax Number	:	580-548-1583

Provider Business Practice Location Address
First Line	:	1084 NICKERSON ST
Second Line	:
City	:	WAYNOKA
State	:	OK
Zip	:	73860-1245
Country	:	US
Telephone Number	:	580-824-2291
Fax Number	:	580-824-0429

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	04/05/2017

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