Basic Information
| Provider Information | |||||||||
| NPI: | 1285618017 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VERCHER | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | PA C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8039 WASHINGTON VILLAGE DRIVE | ||||||||
| Address2: | STE 100 | ||||||||
| City: | CENTERVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454583859 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9374358999 | ||||||||
| FaxNumber: | 9374354211 | ||||||||
| Practice Location | |||||||||
| Address1: | 8039 WASHINGTON VILLAGE DRIVE | ||||||||
| Address2: | STE 100 | ||||||||
| City: | CENTERVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9374358999 | ||||||||
| FaxNumber: | 9374354211 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2005 | ||||||||
| LastUpdateDate: | 11/07/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 50002060 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 0893476 | 05 | OH | MEDICAID |