Individual
DR. GARY L JENISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, PHD
Contact information
Practice address
80 STAR DR, CHILLICOTHE, OH 45601-9583
(740) 779-2233
(740) 779-2234
Mailing address
PO BOX 105, CHILLICOTHE, OH 45601-0105
(740) 779-2233
(740) 779-2234
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
35069046
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0231592
—
OH
01
—
040010891
RAILROAD MEDICARE PIN NUM
OH
Enumeration date
06/22/2005
Last updated
11/17/2011
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