Provider Demographics
NPI:1396742078
Name:SAYRE, JOE W (MD)
Entity type:Individual
Prefix:
First Name:JOE
Middle Name:W
Last Name:SAYRE
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 1:1250 RALSTON AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:DEFIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:43512-5311
Mailing Address - Country:US
Mailing Address - Phone:419-783-6997
Mailing Address - Fax:419-782-6873
Practice Address - Street 1:1250 RALSTON AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:DEFIANCE
Practice Address - State:OH
Practice Address - Zip Code:43512-5311
Practice Address - Country:US
Practice Address - Phone:419-783-6997
Practice Address - Fax:419-782-6873
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35050180S208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0635905Medicaid
00331OtherPARAMOUNT
000000576671OtherANTHEM
04062385OtherAETNA
OHP00667926OtherRRMC
OHP00667926OtherRRMC
OH0635905Medicaid
OH0591406Medicare PIN