Individual
JEREMY GANZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
27TH SPECIAL OPERATIONS MEDICAL GROUP, 224 W D. L. INGRAM AVENUE, BLDG. 1408, CLOVIS, NM 88103
(314) 226-8463
Mailing address
27TH SPECIAL OPERATIONS MEDICAL GROUP, 224 W D. L. INGRAM AVENUE, BLDG. 1408, CANNON AFB, NM 88103
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
—
—
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
06/18/2018
Last updated
01/22/2024
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