Healthcare Provider Details

I. General information

NPI: 1396742078
Provider Name (Legal Business Name): JOE W SAYRE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 03/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 RALSTON AVE SUITE 203
DEFIANCE OH
43512-5311
US

IV. Provider business mailing address

1250 RALSTON AVE SUITE 203
DEFIANCE OH
43512-5311
US

V. Phone/Fax

Practice location:
  • Phone: 419-783-6997
  • Fax: 419-782-6873
Mailing address:
  • Phone: 419-783-6997
  • Fax: 419-782-6873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35050180S
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: