Provider Demographics
NPI:1881628980
Name:JUMP, DAVID ALLEN (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ALLEN
Last Name:JUMP
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 NEAL ZICK RD
Mailing Address - Street 2:
Mailing Address - City:WILLARD
Mailing Address - State:OH
Mailing Address - Zip Code:44890-9287
Mailing Address - Country:US
Mailing Address - Phone:419-933-2811
Mailing Address - Fax:419-933-4502
Practice Address - Street 1:1100 NEAL ZICK RD
Practice Address - Street 2:
Practice Address - City:WILLARD
Practice Address - State:OH
Practice Address - Zip Code:44890-9287
Practice Address - Country:US
Practice Address - Phone:419-933-2811
Practice Address - Fax:419-933-4502
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-3318207Q00000X
OH34003318207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH488913Medicaid
OH34003318OtherOH MEDICAL LICENSE
OHA15225Medicare UPIN
OHH114290Medicare PIN