Provider Demographics
NPI:1750389748
Name:BARNETT, JAYSON W (MD)
Entity type:Individual
Prefix:DR
First Name:JAYSON
Middle Name:W
Last Name:BARNETT
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 1:110 WILLOWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-8174
Mailing Address - Country:US
Mailing Address - Phone:937-422-2134
Mailing Address - Fax:
Practice Address - Street 1:2142 N COVE BLVD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3895
Practice Address - Country:US
Practice Address - Phone:419-471-4491
Practice Address - Fax:419-479-6905
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35063810207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH050089498OtherRAILROAD MEDICARE
OH2356767Medicaid
OH050089498OtherRAILROAD MEDICARE
OH4089081Medicare ID - Type UnspecifiedOHIO MEDICARE
OH4089083Medicare ID - Type UnspecifiedOHIO MEDICARE
OH4089082Medicare ID - Type UnspecifiedOHIO MEDICARE
OH050089498OtherRAILROAD MEDICARE
OH2356767OtherBCMH