MEDICARE: JERAMY D SAWYERS PA

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	171000000X	Military Health Care Provider
2	363A00000X	Physician Assistant	1161404

General Provider Information

NPI Number	:	1265614069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERAMY D SAWYERS PA

Provider Business Mailing Address
First Line	:	PSC 561 BOX 157
Second Line	:
City	:	FPO
State	:	AP
Zip	:	96310-0002
Country	:	US
Telephone Number	:	619-606-1250
Fax Number	:

Provider Business Practice Location Address
First Line	:	MARINE CORPS AIR STATION IWAKUNI, JAPAN
Second Line	:	BRANCH HEALTH CLINIC
City	:	FPO
State	:	AP
Zip	:	96310
Country	:	US
Telephone Number	:	315-255-8100
Fax Number	:

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

Provider Enumeration Date	:	12/04/2007
Last Update Date	:	11/10/2019

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