Provider Demographics
NPI:1376931105
Name:CRITTENDEN, JACOB KEITH III (MD)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:KEITH
Last Name:CRITTENDEN
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:621 TUSCULUM AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45226-1771
Mailing Address - Country:US
Mailing Address - Phone:702-232-2336
Mailing Address - Fax:702-646-3243
Practice Address - Street 1:621 TUSCULUM AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45226-1771
Practice Address - Country:US
Practice Address - Phone:702-232-2336
Practice Address - Fax:702-646-3243
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-01
Last Update Date:2015-01-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35.043691208200000X
KY16223208200000X
FLME 86453208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery