Basic Information
| Provider Information | |||||||||
| NPI: | 1619972379 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PAUL | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 415 GREENWELL AVE | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452385302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135573507 | ||||||||
| FaxNumber: | 5135573506 | ||||||||
| Practice Location | |||||||||
| Address1: | 311 STRAIGHT ST | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452191018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135592236 | ||||||||
| FaxNumber: | 5134755252 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2005 | ||||||||
| LastUpdateDate: | 04/10/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 35045631P | OH | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2266597 | 05 | OH | MEDICAID | 64-041841 | 05 | KY | MEDICAID |