Provider Demographics
NPI:1093541641
Name:FOLTZ, DERON JAY (RT(R)(MR))
Entity type:Individual
Prefix:
First Name:DERON
Middle Name:JAY
Last Name:FOLTZ
Suffix:
Gender:M
Credentials:RT(R)(MR)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11939 STATE ROUTE 138 SW
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45123-8107
Mailing Address - Country:US
Mailing Address - Phone:937-403-6630
Mailing Address - Fax:
Practice Address - Street 1:11939 STATE ROUTE 138 SW
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:OH
Practice Address - Zip Code:45123-8107
Practice Address - Country:US
Practice Address - Phone:937-403-6630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3837882085B0100X
OH88550152085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging