Healthcare Provider Details

I. General information

NPI: 1376786004
Provider Name (Legal Business Name): JEFFREY ALAN VERNON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2009
Last Update Date: 06/29/2025
Certification Date: 06/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 GOODMAN STREET
CINCINNATI OH
45219-0796
US

IV. Provider business mailing address

1 W 4TH ST APT 1406
CINCINNATI OH
45202-3856
US

V. Phone/Fax

Practice location:
  • Phone: 513-558-0119
  • Fax: 513-558-4887
Mailing address:
  • Phone: 917-725-0762
  • Fax: 905-963-1689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number252671
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number34.015473
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: