Healthcare Provider Details

I. General information

NPI: 1265614069
Provider Name (Legal Business Name): JERAMY D SAWYERS PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2007
Last Update Date: 11/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MARINE CORPS AIR STATION IWAKUNI, JAPAN BRANCH HEALTH CLINIC
FPO AP
96310
US

IV. Provider business mailing address

PSC 561 BOX 157
FPO AP
96310-0002
US

V. Phone/Fax

Practice location:
  • Phone: 315-255-8100
  • Fax:
Mailing address:
  • Phone: 619-606-1250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1161404
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: