Healthcare Provider Details

I. General information

NPI: 1821073230
Provider Name (Legal Business Name): JERRY B MAGONE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 12/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 N BREIEL BLVD
MIDDLETOWN OH
45042-3807
US

IV. Provider business mailing address

275 N BREIEL BLVD
MIDDLETOWN OH
45042-3807
US

V. Phone/Fax

Practice location:
  • Phone: 513-424-7711
  • Fax: 513-424-3599
Mailing address:
  • Phone: 513-424-7711
  • Fax: 513-424-3599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number35.050466
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: