Provider Demographics
NPI:1750374849
Name:MCDANIEL, JERRY HAYES (MD)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:HAYES
Last Name:MCDANIEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:375 GLENSPRINGS DR
Mailing Address - Street 2:SUITE 410
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-2316
Mailing Address - Country:US
Mailing Address - Phone:513-851-6500
Mailing Address - Fax:513-851-6502
Practice Address - Street 1:375 GLENSPRINGS DR
Practice Address - Street 2:SUITE 410
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-2316
Practice Address - Country:US
Practice Address - Phone:513-851-6500
Practice Address - Fax:513-851-6502
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35047141208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3153242Medicaid
OH0489921Medicaid