MEDICARE: TOM H PEPPER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RA0401X	Addiction Medicine (Internal Medicine) Physician	35052757	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598704710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TOM H PEPPER MD

Provider Business Mailing Address
First Line	:	1492 E. BROAD ST.
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43205-1546
Country	:	US
Telephone Number	:	614-257-3760
Fax Number	:	614-257-3439

Provider Business Practice Location Address
First Line	:	1492 E BROAD ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43205-1546
Country	:	US
Telephone Number	:	614-257-3760
Fax Number	:	614-257-3439

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	10/20/2009

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Directions to “ TOM H PEPPER MD” Practice Location

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