Provider Demographics
NPI:1083694301
Name:JENNINGS, RICHARD F (DPM)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:F
Last Name:JENNINGS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-1581
Mailing Address - Country:US
Mailing Address - Phone:937-322-3346
Mailing Address - Fax:937-322-3348
Practice Address - Street 1:1400 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-1581
Practice Address - Country:US
Practice Address - Phone:937-599-3668
Practice Address - Fax:937-599-4852
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003153213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH159820OtherMEDICARE