=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841279395
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REMUS NERVEZ MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/12/2006
-----------------------------------------------------
Last Update Date | 03/05/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1601 W BROAD ST
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43222-1054
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-272-0509
-----------------------------------------------------
Fax | 614-272-1054
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1601 W BROAD ST
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43222-1054
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-272-0509
-----------------------------------------------------
Fax | 614-272-1054
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 35063792N
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------