Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 1088 | SC |
N | 207Q00000X | Family Doctor | 200600893 | NC |
Y | 207Q00000X | Family Doctor | 34008458 | OH |
N | 207QS0010X | Family Doctor - Sports Medicine | 1088 | SC |
N | 207QS0010X | Family Doctor - Sports Medicine | 200600893 | NC |
N | 207QS0010X | Family Doctor - Sports Medicine | 34008458 | OH |
NPI | 1104029917 |
---|---|
Provider Name | John Fulton Hedge |
First Address | Dublin, OH 43016-4134 |
Second Address | Columbus, OH 43214-3467 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2007 |
Last Update Date | 25/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010883 | (05) | SC |
1088 | MEDICAL LICENSE (01) | SC |
5916171 | (05) | NC |
P00436180 | RAILROAD MEDICARE PTAN (01) | SC |
PENDING | (05) | OH |