Provider Demographics
NPI:1356630818
Name:GOZAL, YAIR MENACHEM (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:YAIR
Middle Name:MENACHEM
Last Name:GOZAL
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 643398
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45264-3398
Mailing Address - Country:US
Mailing Address - Phone:513-221-1100
Mailing Address - Fax:513-569-5297
Practice Address - Street 1:3825 EDWARDS RD STE 300
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45209
Practice Address - Country:US
Practice Address - Phone:513-221-1100
Practice Address - Fax:513-569-5297
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10277910207T00000X
390200000X
OH35.120370207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0267334Medicaid
KY7100509690Medicaid