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Individual
DR. JOHN P DETHERAGE III
Active
Individual
DR. JOHN P DETHERAGE III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
01098271A
IN
207P00000X
Emergency Medicine Physician
35150486
OH
207P00000X
Emergency Medicine Physician
59124
KY
207PS0010X
Sports Medicine (Emergency Medicine) Physician
01098271A
IN
207PS0010X
Sports Medicine (Emergency Medicine) Physician
Primary
35150486
OH
207PS0010X
Sports Medicine (Emergency Medicine) Physician
59124
KY
Other
Enumeration date
05/05/2021
Last updated
10/14/2026
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