Provider Demographics
NPI:1770671232
Name:DONOHOO, JEFFREY (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:DONOHOO
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 1:415 HOME ST
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45121-1478
Mailing Address - Country:US
Mailing Address - Phone:937-378-1008
Mailing Address - Fax:937-378-1012
Practice Address - Street 1:415 HOME ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:OH
Practice Address - Zip Code:45121-1478
Practice Address - Country:US
Practice Address - Phone:937-378-1008
Practice Address - Fax:937-378-1012
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.048153207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0555662Medicaid
OH0555662Medicaid
OHDO7204171Medicare ID - Type Unspecified