Healthcare Provider Details

I. General information

NPI: 1700142734
Provider Name (Legal Business Name): JEFFREY AARON JAMES DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2012
Last Update Date: 10/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 MIAMI VALLEY DR STE 320A
DAYTON OH
45459-4778
US

IV. Provider business mailing address

3170 KETTERING BLVD BLDG B3
MORAINE OH
45439-1924
US

V. Phone/Fax

Practice location:
  • Phone: 937-312-1661
  • Fax: 937-312-1701
Mailing address:
  • Phone: 937-991-3188
  • Fax: 937-223-9811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number34.011135
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: