Provider Demographics
NPI:1912122334
Name:PAES, JOHN E (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:E
Last Name:PAES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 W SCHROCK RD
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-2890
Mailing Address - Country:US
Mailing Address - Phone:614-392-5160
Mailing Address - Fax:614-392-5161
Practice Address - Street 1:193 W SCHROCK RD
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-2890
Practice Address - Country:US
Practice Address - Phone:614-392-5160
Practice Address - Fax:614-392-5161
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34008529207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2766350Medicaid
OH2766350Medicaid