Individual
JEFF P JOLLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1615 DELAWARE ST, LONGVIEW, WA 98632-2310
(360) 414-2360
(360) 414-2361
Mailing address
PO BOX 249, LONGVIEW, WA 98632-7154
(360) 414-2000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA10002542
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
134929
LABOR & IND.
WA
05
—
8324048
—
WA
01
—
8908756
CRIME VICTIMS
WA
Enumeration date
07/07/2005
Last updated
07/08/2007
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