Provider Demographics
NPI:1326571878
Name:BLANK, JEFFREY CHARLES (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:CHARLES
Last Name:BLANK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1114 PINNACLE CLUB DR
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-8184
Mailing Address - Country:US
Mailing Address - Phone:917-659-3653
Mailing Address - Fax:
Practice Address - Street 1:5300 N MEADOWS DR
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-2546
Practice Address - Country:US
Practice Address - Phone:614-663-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-11
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH00000000000000390200000X
OH34.013997207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program