Healthcare Provider Details

I. General information

NPI: 1598704710
Provider Name (Legal Business Name): TOM H PEPPER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 10/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1492 E BROAD ST
COLUMBUS OH
43205-1546
US

IV. Provider business mailing address

1492 E. BROAD ST.
COLUMBUS OH
43205-1546
US

V. Phone/Fax

Practice location:
  • Phone: 614-257-3760
  • Fax: 614-257-3439
Mailing address:
  • Phone: 614-257-3760
  • Fax: 614-257-3439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number35052757
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: