Healthcare Provider Details

I. General information

NPI: 1043509466
Provider Name (Legal Business Name): AVNER DAGAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2011
Last Update Date: 04/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10500 MONTGOMERY RD
CINCINNATI OH
45242-4402
US

IV. Provider business mailing address

PO BOX 640738
CINCINNATI OH
45264-0738
US

V. Phone/Fax

Practice location:
  • Phone: 513-865-1111
  • Fax: 859-341-7867
Mailing address:
  • Phone: 859-341-2666
  • Fax: 859-341-7867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number074467
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: