MEDICARE: MR. LAVERN K SCHEPP P.A.

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	1287	ND

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	:	1619055662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LAVERN K SCHEPP P.A.

Provider Business Mailing Address
First Line	:	3450 N 3RD ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85012-2331
Country	:	US
Telephone Number	:	602-265-8338
Fax Number	:	602-265-8574

Provider Business Practice Location Address
First Line	:	1424 S 7TH AVE BLDG C
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85007-3902
Country	:	US
Telephone Number	:	602-258-3600
Fax Number	:	602-256-0514

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	04/14/2008

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Directions to “ MR. LAVERN K SCHEPP P.A.” Practice Location

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