Healthcare Provider Details

I. General information

NPI: 1619617701
Provider Name (Legal Business Name): GREGORY CHARLES WETMORE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 03/29/2022
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 GOODMAN ST
CINCINNATI OH
45219-2364
US

IV. Provider business mailing address

DEPARTMENT OF SURGERY 231 ALBERT SABIN WAY ML 0558
CINCINNATI OH
45267-0558
US

V. Phone/Fax

Practice location:
  • Phone: 513-558-4206
  • Fax: 513-558-3474
Mailing address:
  • Phone: 513-558-4206
  • Fax: 513-558-3474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: