Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 35040954C | OH |
Y | 207RA0401X | Internist - Addiction Medicine | 35040954 | OH |
NPI | 1104821206 |
---|---|
Provider Name | Dr. Jeffrey Craven |
First Address | Cincinnati, OH 45206-2348 |
Second Address | Cincinnati, OH 45239 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2005 |
Last Update Date | 02/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0531393 | (05) | OH |