Provider Demographics
NPI:1548209893
Name:STANDLEY, JEFFREY C (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:C
Last Name:STANDLEY
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 1:9825 KENWOOD RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-6251
Mailing Address - Country:US
Mailing Address - Phone:513-872-4500
Mailing Address - Fax:513-872-4518
Practice Address - Street 1:9825 KENWOOD RD
Practice Address - Street 2:SUITE 105
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-6251
Practice Address - Country:US
Practice Address - Phone:513-872-4500
Practice Address - Fax:513-872-4518
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350494412085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0533757Medicaid
IN200251410Medicaid
KY64005440Medicaid
OHB46052Medicare UPIN
OH300105256Medicare PIN
OH0585939Medicare PIN
OH0585938Medicare PIN
OH0585937Medicare PIN
OH0585934Medicare PIN
OH0585935Medicare PIN