Healthcare Provider Details

I. General information

NPI: 1629008628
Provider Name (Legal Business Name): SAMUEL RUSSELL VESTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 07/14/2023
Certification Date: 07/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3188 BELLEVUE AVE
CINCINNATI OH
45219-2369
US

IV. Provider business mailing address

4750 E GALBRAITH RD STE 215
CINCINNATI OH
45236-6706
US

V. Phone/Fax

Practice location:
  • Phone: 513-475-8787
  • Fax: 513-929-7239
Mailing address:
  • Phone: 513-421-3494
  • Fax: 513-345-2606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35061926V
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number35.061926
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number29644
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number29644
License Number StateKY
# 5
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number35061926V
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: