Provider Demographics
NPI:1437141207
Name:PRESCOTT, JON S (MD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:S
Last Name:PRESCOTT
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 1:2865 E COAST HWY
Mailing Address - Street 2:210
Mailing Address - City:CORONA DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92625-2236
Mailing Address - Country:US
Mailing Address - Phone:440-244-0725
Mailing Address - Fax:440-244-0726
Practice Address - Street 1:5260 SMITH RD
Practice Address - Street 2:
Practice Address - City:BROOKPARK
Practice Address - State:OH
Practice Address - Zip Code:44142-1747
Practice Address - Country:US
Practice Address - Phone:216-265-4581
Practice Address - Fax:216-265-4581
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350624302085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0141073Medicaid
OHPR4125961Medicare ID - Type UnspecifiedCHP
OH0141073Medicaid
OHPR0873935Medicare PIN
OH920007346Medicare PIN