MEDICARE: JEFFERY L STAMBOUGH 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
1	207X00000X	Orthopaedic Surgery Physician	35053396	OH
2	207XS0114X	Adult Reconstructive Orthopaedic Surgery Physician	35053396	OH
3	207XS0117X	Orthopaedic Surgery of the Spine Physician	35053396	OH

Other Identifiers

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

General Provider Information

NPI Number	:	1891778866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFERY L STAMBOUGH MD

Provider Business Mailing Address
First Line	:	4685 FOREST AVE
Second Line	:	STE C
City	:	CINCINNATI
State	:	OH
Zip	:	45212-3359
Country	:	US
Telephone Number	:	513-853-4749
Fax Number	:	513-853-4740

Provider Business Practice Location Address
First Line	:	4600 SMITH RD
Second Line	:	SUITE B
City	:	NORWOOD
State	:	OH
Zip	:	45212-2793
Country	:	US
Telephone Number	:	513-221-4848
Fax Number	:	513-872-7825

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/23/2005
Last Update Date	:	04/15/2016

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Directions to “ JEFFERY L STAMBOUGH MD” Practice Location

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