Provider Demographics
NPI:1346279718
Name:STRAYER, JONATHAN R (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:R
Last Name:STRAYER
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 1:260 STETSON STREET
Mailing Address - Street 2:ML 0530 SUITE 5200
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45267-0530
Mailing Address - Country:US
Mailing Address - Phone:513-558-2919
Mailing Address - Fax:513-558-4458
Practice Address - Street 1:151 W GALBRAITH RD
Practice Address - Street 2:DRAKE CENTER
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45216-1015
Practice Address - Country:US
Practice Address - Phone:513-418-2707
Practice Address - Fax:513-418-2698
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-082255208100000X, 2081P0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P0004XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSpinal Cord Injury Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
10799933OtherCAQH
OH2432308Medicaid
000000277821OtherANTHEM
KY64073893Medicaid
10799933OtherCAQH
OH2432308Medicaid
KY64073893Medicaid