Healthcare Provider Details

I. General information

NPI: 1336107366
Provider Name (Legal Business Name): JENNIFER BLAIR RICHARD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 11/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4371 FERGUSON DR
CINCINNATI OH
45245-1668
US

IV. Provider business mailing address

6859 OBANNON BLF
LOVELAND OH
45140-6018
US

V. Phone/Fax

Practice location:
  • Phone: 513-752-3650
  • Fax: 513-752-3387
Mailing address:
  • Phone: 513-683-1568
  • Fax: 513-752-3387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35072320
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: