Healthcare Provider Details

I. General information

NPI: 1720076714
Provider Name (Legal Business Name): JONATHAN ALSPAUGH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 EUCLID AVE C/O JILL POHLMAN
CINCINNATI OH
45219-2102
US

IV. Provider business mailing address

234 GOODMAN ST ML 0761
CINCINNATI OH
45267-1000
US

V. Phone/Fax

Practice location:
  • Phone: 513-618-2848
  • Fax: 513-618-2849
Mailing address:
  • Phone: 513-584-4391
  • Fax: 513-584-0431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number35041696
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: