Provider Demographics
NPI:1588665582
Name:PELFREY, JO YVETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:JO
Middle Name:YVETTE
Last Name:PELFREY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5678 FAR HILLS AVE
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-2206
Mailing Address - Country:US
Mailing Address - Phone:937-434-4323
Mailing Address - Fax:937-434-4541
Practice Address - Street 1:5678 FAR HILLS AVE
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-2206
Practice Address - Country:US
Practice Address - Phone:937-434-4323
Practice Address - Fax:937-434-4541
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35054725207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0702663Medicaid
OH000000015667OtherANTHEM
OH0702663Medicaid