Healthcare Provider Details

I. General information

NPI: 1750374849
Provider Name (Legal Business Name): JERRY HAYES MCDANIEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 03/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 GLENSPRINGS DR SUITE 410
CINCINNATI OH
45246-2316
US

IV. Provider business mailing address

375 GLENSPRINGS DR SUITE 410
CINCINNATI OH
45246-2316
US

V. Phone/Fax

Practice location:
  • Phone: 513-851-6500
  • Fax: 513-851-6502
Mailing address:
  • Phone: 513-851-6500
  • Fax: 513-851-6502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35047141
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: