Healthcare Provider Details

I. General information

NPI: 1821087610
Provider Name (Legal Business Name): JOHN A IRETON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 STATE ROUTE 664 N UNIT A
LOGAN OH
43138-9250
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 740-385-9646
  • Fax: 740-385-0630
Mailing address:
  • Phone: 740-380-8000
  • Fax: 614-293-2809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number34.008170
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number34008170
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: