Provider Demographics
NPI:1518907203
Name:ENGLE, JOHN R (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:ENGLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:241 EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-6307
Mailing Address - Country:US
Mailing Address - Phone:740-387-3256
Mailing Address - Fax:740-383-4906
Practice Address - Street 1:241 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6307
Practice Address - Country:US
Practice Address - Phone:740-387-3256
Practice Address - Fax:740-383-4906
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.042439207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0458811Medicaid
OH0458811Medicaid
OHH463860Medicare PIN
MEC66407Medicare UPIN