Healthcare Provider Details

I. General information

NPI: 1720819949
Provider Name (Legal Business Name): EDWARD JEON PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2024
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E PRESTON ST
MOUNT PLEASANT MI
48859-2013
US

IV. Provider business mailing address

600 E PRESTON ST
MOUNT PLEASANT MI
48859-2013
US

V. Phone/Fax

Practice location:
  • Phone: 989-774-6599
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA18239
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: