Provider Demographics
NPI:1770569741
Name:SPERBER, JODI I (DO)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:I
Last Name:SPERBER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 E APPLE ST
Mailing Address - Street 2:SUITE 6250
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409-2939
Mailing Address - Country:US
Mailing Address - Phone:937-208-8394
Mailing Address - Fax:937-208-8388
Practice Address - Street 1:30 E APPLE ST
Practice Address - Street 2:SUITE 6250
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2939
Practice Address - Country:US
Practice Address - Phone:937-208-8394
Practice Address - Fax:937-208-8388
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007948207Q00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH421534506101OtherCARESOURCE
OH7051609OtherAETNA
OH000000344885OtherANTHEM
OH000000344885OtherUNICARE
OH0113407OtherUNITED HEALTH CARE
OHD0794801OtherHUMANA/CHOICECARE
OH2538025Medicaid
OH2538025Medicaid
OHH087451Medicare PIN
OHI21960Medicare UPIN
OHSP4147882Medicare PIN