MEDICARE: JEFFREY MATTHEW SCHMIDT 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	363AM0700X	Medical Physician Assistant	PA.0003541	CO

General Provider Information

NPI Number	:	1699093229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY MATTHEW SCHMIDT PA-C

Provider Business Mailing Address
First Line	:	575 KINCHELOE LOOP
Second Line	:	PETERSON AFB
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80926
Country	:	US
Telephone Number	:	719-554-9717
Fax Number	:

Provider Business Practice Location Address
First Line	:	575 KINCHELOE LOOP
Second Line	:	PETERSON AFB
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80926
Country	:	US
Telephone Number	:	719-554-9717
Fax Number	:

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

Provider Enumeration Date	:	05/06/2010
Last Update Date	:	12/05/2022

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