Provider Demographics
NPI:1821087610
Name:IRETON, JOHN A (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:IRETON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:740-380-8000
Mailing Address - Fax:614-293-2809
Practice Address - Street 1:751 STATE ROUTE 664 N UNIT A
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:OH
Practice Address - Zip Code:43138-9250
Practice Address - Country:US
Practice Address - Phone:740-385-9646
Practice Address - Fax:740-385-0630
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.008170208M00000X
OH34008170207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000319556OtherANTHEM
51048032500OtherWC
OH2449774Medicaid
000000319556OtherANTHEM
H96907Medicare UPIN