Basic Information
| Provider Information | |||||||||
| NPI: | 1205162690 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VOVAN | ||||||||
| FirstName: | HOUSTON | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 636799 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452631395 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138623452 | ||||||||
| FaxNumber: | 5138623421 | ||||||||
| Practice Location | |||||||||
| Address1: | 375 DIXMYTH AVE | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452202475 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138623452 | ||||||||
| FaxNumber: | 5138623421 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2009 | ||||||||
| LastUpdateDate: | 05/30/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 35094311 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 35094311 | OH | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 2994032 | 05 | OH | MEDICAID | P00934758 | 01 | OH | RAILROAD MEDICARE | OTHER |