=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760447619
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEFFREY THOMAS JANNING MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/20/2006
-----------------------------------------------------
Last Update Date | 10/09/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 830 THOMAS MORE PKWY SUITE 200 A
-----------------------------------------------------
City | EDGEWOOD
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41017-5102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-341-3383
-----------------------------------------------------
Fax | 859-578-2013
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 635283
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45263-5283
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-341-3383
-----------------------------------------------------
Fax | 859-578-2013
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 25586
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------