Healthcare Provider Details

I. General information

NPI: 1609854355
Provider Name (Legal Business Name): DAVID J HILLIARD D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

639 W MAIN ST
BARNESVILLE OH
43713-1039
US

IV. Provider business mailing address

639 W. MAIN ST. P.O. BOX 309
BARNESVILLE OH
43713-0309
US

V. Phone/Fax

Practice location:
  • Phone: 740-425-3941
  • Fax: 740-425-5192
Mailing address:
  • Phone: 740-425-3941
  • Fax: 740-425-5192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number34004816
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: