Provider Demographics
NPI:1558770396
Name:DUMFORD, JARROD
Entity Type:Individual
Prefix:
First Name:JARROD
Middle Name:
Last Name:DUMFORD
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:PO BOX 316
Mailing Address - Street 2:
Mailing Address - City:OWENSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45160
Mailing Address - Country:US
Mailing Address - Phone:513-290-8426
Mailing Address - Fax:
Practice Address - Street 1:18251 GAUCHE RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:OH
Practice Address - Zip Code:45118
Practice Address - Country:US
Practice Address - Phone:513-290-8426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-06
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SY197034374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide