Healthcare Provider Details

I. General information

NPI: 1205306818
Provider Name (Legal Business Name): ROBERT HEARON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2018
Last Update Date: 11/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2621 VICTORY PKWY
CINCINNATI OH
45206-1754
US

IV. Provider business mailing address

2621 VICTORY PKWY
CINCINNATI OH
45206-1754
US

V. Phone/Fax

Practice location:
  • Phone: 513-751-7747
  • Fax:
Mailing address:
  • Phone: 513-751-7747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: