Healthcare Provider Details

I. General information

NPI: 1255381463
Provider Name (Legal Business Name): JOHN C JUMP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 SOUTHERN BLVD
KETTERING OH
45429-1221
US

IV. Provider business mailing address

PO BOX 750245
DAYTON OH
45475-0245
US

V. Phone/Fax

Practice location:
  • Phone: 937-395-8666
  • Fax:
Mailing address:
  • Phone: 937-438-9500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number35039092
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: