Healthcare Provider Details

I. General information

NPI: 1790869899
Provider Name (Legal Business Name): JOHN EDWARD PHAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 01/07/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 KENNY RD
COLUMBUS OH
43221-3502
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-7171
  • Fax: 614-293-3465
Mailing address:
  • Phone: 614-293-7171
  • Fax: 614-293-3277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number35093740
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: