Healthcare Provider Details

I. General information

NPI: 1629076898
Provider Name (Legal Business Name): JEFF BARE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 03/24/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 W MAIN ST
NEWARK OH
43055-1822
US

IV. Provider business mailing address

1320 W MAIN ST
NEWARK OH
43055-1822
US

V. Phone/Fax

Practice location:
  • Phone: 220-564-4151
  • Fax: 220-564-7153
Mailing address:
  • Phone: 220-564-4151
  • Fax: 220-564-7153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number34006997
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: