Basic Information
| Provider Information | |||||||||
| NPI: | 1770569741 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SPERBER | ||||||||
| FirstName: | JODI | ||||||||
| MiddleName: | I | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30 E APPLE ST | ||||||||
| Address2: | SUITE 6250 | ||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454092939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372088394 | ||||||||
| FaxNumber: | 9372088388 | ||||||||
| Practice Location | |||||||||
| Address1: | 30 E APPLE ST | ||||||||
| Address2: | SUITE 6250 | ||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454092939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372088394 | ||||||||
| FaxNumber: | 9372088388 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2005 | ||||||||
| LastUpdateDate: | 02/14/2013 | ||||||||
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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 | 207Q00000X | 34007948 | OH | N | Allopathic & Osteopathic Physicians | Family Medicine | 208M00000X | 34007948 | OH | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 421534506101 | 01 | OH | CARESOURCE | OTHER | 7051609 | 01 | OH | AETNA | OTHER | 000000344885 | 01 | OH | ANTHEM | OTHER | 000000344885 | 01 | OH | UNICARE | OTHER | 0113407 | 01 | OH | UNITED HEALTH CARE | OTHER | D0794801 | 01 | OH | HUMANA/CHOICECARE | OTHER | 2538025 | 05 | OH | MEDICAID |