Provider Demographics
NPI:1417974056
Name:JENTES, JOHN P (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:JENTES
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:PO BOX 72098
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44192-0002
Mailing Address - Country:US
Mailing Address - Phone:513-557-3195
Mailing Address - Fax:513-557-3347
Practice Address - Street 1:350 HILLCREST DR
Practice Address - Street 2:SUITE 3
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-4052
Practice Address - Country:US
Practice Address - Phone:419-207-2502
Practice Address - Fax:419-207-2394
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-03-7562-J207P00000X
OH35-037562207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0336523Medicaid
OHJE0435563Medicare PIN
A36722Medicare UPIN