Provider Demographics
NPI:1225201049
Name:STANDRIDGE, JEREMY SHAWN (DO)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:SHAWN
Last Name:STANDRIDGE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3503 BRENTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45208-1712
Mailing Address - Country:US
Mailing Address - Phone:614-214-1815
Mailing Address - Fax:
Practice Address - Street 1:4623 WESLEY AVE
Practice Address - Street 2:SUITE C
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45212-2246
Practice Address - Country:US
Practice Address - Phone:513-841-1122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-13
Last Update Date:2008-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0088982083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine