Provider Demographics
NPI:1558311043
Name:BILL, JEFFREY PAUL
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:PAUL
Last Name:BILL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6460 HARRISON AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45247-7958
Mailing Address - Country:US
Mailing Address - Phone:513-941-4999
Mailing Address - Fax:513-941-7555
Practice Address - Street 1:6460 HARRISON AVE STE 100
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45247-7958
Practice Address - Country:US
Practice Address - Phone:513-941-4999
Practice Address - Fax:513-941-7555
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.086730207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2641832Medicaid
OH2683609Medicaid
OH4182002Medicare PIN