Healthcare Provider Details

I. General information

NPI: 1144288259
Provider Name (Legal Business Name): JEFFREY EUGENE SIZEMORE III D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 02/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 WOODBINE ST
WILLARD OH
44890-1635
US

IV. Provider business mailing address

740 WOODBINE ST
WILLARD OH
44890-1635
US

V. Phone/Fax

Practice location:
  • Phone: 419-935-6761
  • Fax: 419-933-1676
Mailing address:
  • Phone: 419-935-6761
  • Fax: 419-933-1676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34004191
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: