Healthcare Provider Details

I. General information

NPI: 1669408811
Provider Name (Legal Business Name): JEFFREY BORY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 N 1ST ST
DENNISON OH
44621-1003
US

IV. Provider business mailing address

2184 CANTON RD NW
CARROLLTON OH
44615-8619
US

V. Phone/Fax

Practice location:
  • Phone: 740-922-2800
  • Fax: 740-922-2800
Mailing address:
  • Phone: 330-627-8176
  • Fax: 330-627-8176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35-064884
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: