Provider Demographics
NPI:1881637460
Name:KERBO, JOHN D (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:KERBO
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 1:4130 DRY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45252-1914
Mailing Address - Country:US
Mailing Address - Phone:513-981-5162
Mailing Address - Fax:513-923-5522
Practice Address - Street 1:4130 DRY RIDGE RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45252-1914
Practice Address - Country:US
Practice Address - Phone:513-981-5162
Practice Address - Fax:513-923-5522
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006135207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0246915Medicaid
OH4225753Medicare PIN
OHG19391Medicare UPIN