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NPI Code Detail

MEDICARE: JEROME PURYEAR JR. MD

MEDICARE: JEROME PURYEAR JR. MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology Physician35087047OH
22085R0202XDiagnostic Radiology Physician036154471IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1255381000
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEROME PURYEAR JR. MD
Provider Business Mailing Address
First Line : BOX 713083
Second Line :
City : COLUMBUS
State : OH
Zip : 43271-3083
Country : US
Telephone Number : 614-430-5707
Fax Number :
Provider Business Practice Location Address
First Line : 3535 SOUTHERN BLVD
Second Line :
City : KETTERING
State : OH
Zip : 45429-1221
Country : US
Telephone Number : 937-296-7202
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2006
Last Update Date : 03/03/2026

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