Provider Demographics
NPI:1235457268
Name:GUNZENHAEUSER, JACOB MAXWELL (MD)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:MAXWELL
Last Name:GUNZENHAEUSER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4460 RED BANK EXPRESSWAY
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45227-2173
Mailing Address - Country:US
Mailing Address - Phone:513-791-5200
Mailing Address - Fax:513-791-5229
Practice Address - Street 1:4460 RED BANK EXPRESSWAY
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45227-2173
Practice Address - Country:US
Practice Address - Phone:513-791-5200
Practice Address - Fax:513-791-5229
Is Sole Proprietor?:No
Enumeration Date:2010-05-14
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-128553207X00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program