Provider Demographics
NPI:1770591562
Name:MATSUURA, JOHN HENRY (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HENRY
Last Name:MATSUURA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 MIAMI VALLEY DR
Mailing Address - Street 2:STE 350
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-1294
Mailing Address - Country:US
Mailing Address - Phone:937-438-8640
Mailing Address - Fax:
Practice Address - Street 1:2300 MIAMI VALLEY DR STE 350
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-1294
Practice Address - Country:US
Practice Address - Phone:937-424-2469
Practice Address - Fax:937-424-2479
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA374032086S0129X
HIMD-208522086S0129X
OH35.05755102086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0080833Medicaid
GA00713325IMedicaid
GA00713325IMedicaid