Provider Demographics
NPI:1295768174
Name:OHARRIZ, JUAN JOSE (MD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:JOSE
Last Name:OHARRIZ
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 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:740-446-5763
Mailing Address - Fax:740-446-5982
Practice Address - Street 1:90 JACKSON PIKE
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-1560
Practice Address - Country:US
Practice Address - Phone:740-446-5763
Practice Address - Fax:740-446-5982
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10463207RG0100X
OH35.122123207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0092812Medicaid
OH0092812Medicaid
PRF25273Medicare UPIN
PR84564Medicare ID - Type Unspecified