Provider Demographics
NPI:1922859370
Name:DEMOTT, JACOB DANIEL (BS)
Entity Type:Individual
Prefix:MR
First Name:JACOB
Middle Name:DANIEL
Last Name:DEMOTT
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 LAVETA CT
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:OH
Mailing Address - Zip Code:45215-2534
Mailing Address - Country:US
Mailing Address - Phone:513-604-4404
Mailing Address - Fax:
Practice Address - Street 1:1 WYOMING ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2722
Practice Address - Country:US
Practice Address - Phone:937-208-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program