Provider Demographics
NPI:1912909185
Name:POON, PHILIP J (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:J
Last Name:POON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:PO BOX 631662
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-1662
Mailing Address - Country:US
Mailing Address - Phone:859-581-7120
Mailing Address - Fax:859-581-7207
Practice Address - Street 1:1577B GOODMAN AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45224-1004
Practice Address - Country:US
Practice Address - Phone:513-729-1321
Practice Address - Fax:513-729-2873
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.039813207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0468588Medicaid
180024728OtherMEDICARE RAILROAD
IN200331110Medicaid
IN200331110Medicaid
180024728OtherMEDICARE RAILROAD