Individual
JEREMY A VITAMVAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
5885 SUNNYBROOK DR, SIOUX CITY, IA 51106-4203
(712) 266-2760
(712) 266-2719
Mailing address
5885 SUNNYBROOK DR, SIOUX CITY, IA 51106-4203
(712) 266-2760
(712) 266-2719
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
001489
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
911858433
—
IA
Enumeration date
07/01/2006
Last updated
08/10/2015
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