Provider Demographics
NPI:1154342582
Name:HILL, JEFFREY RAY (DO)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:RAY
Last Name:HILL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1611 27TH ST
Mailing Address - Street 2:FULTON BUILDING SUITE 301
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-6931
Mailing Address - Country:US
Mailing Address - Phone:740-353-4663
Mailing Address - Fax:740-354-4258
Practice Address - Street 1:1611 27TH ST
Practice Address - Street 2:FULTON BUILDING SUITE 301
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-6931
Practice Address - Country:US
Practice Address - Phone:740-353-4663
Practice Address - Fax:740-354-4258
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.004529207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0748187Medicaid
OH0637222Medicare ID - Type UnspecifiedPROVIDER NUMBER
OH0748187Medicaid