Provider Demographics
NPI:1790755189
Name:JARRETT, JEFFREY A (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:A
Last Name:JARRETT
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 1:3590 BUSENBARK RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:TRENTON
Mailing Address - State:OH
Mailing Address - Zip Code:45067-9552
Mailing Address - Country:US
Mailing Address - Phone:513-988-6369
Mailing Address - Fax:513-988-9369
Practice Address - Street 1:3590 BUSENBARK RD
Practice Address - Street 2:SUITE 400
Practice Address - City:TRENTON
Practice Address - State:OH
Practice Address - Zip Code:45067-9552
Practice Address - Country:US
Practice Address - Phone:513-988-6369
Practice Address - Fax:513-988-9369
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35050456207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0560861Medicaid
OH0560861Medicaid
OHH194520Medicare PIN
OHA15990Medicare UPIN