Jerry Wayne Leisure PA C

NPI 1356556906 - Physician Assistant - 363A00000X

NPI Details
NPI 1356556906
Gender Male
Enumeration Date 05/14/2007
Last Updated 07/10/2015
Entity Type Individual
Active Over 10 years ago
Practice Location
108 6TH ST
Phone (903) 524-4700
Fax (903) 524-4900
Business Location
WASILLA AK, 99654-5327, US
Phone (907) 376-2411
Fax (903) 524-4900
Taxonomy Code 363A00000X
License State Texas
License Number PA00032
Remove 1356556906 NPI Number

According to our database, Mr. Jerry Wayne Leisure PA C NPI is 1356556906, taxonomy code is 363A00000X and license number is PA00032, license state is located at Texas. Jerry Wayne Leisure PA C physically located at 108 6th St, Winfield TX, 75493. NPI Number Jerry Wayne Leisure PA C has the Individual type.

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1356556906 NPI number is provided on an as is basis without warranty of any kind. 1356556906 is maintained by the National Plan & Provider Enumeration System. The contents of Jerry Wayne Leisure PA C are for informational purposes only.