Individual
EFREN C AGANON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1010 HAGER ST, SAINT MARYS, OH 45885-2421
(419) 394-9579
(419) 394-9580
Mailing address
200 SAINT CLAIR AVE, JTDM FAMILY PRACTICE, LLC, SAINT MARYS, OH 45885-2400
(419) 394-3387
(419) 394-9580
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
35077098
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0105065
GROUP MEDICAID
OH
01
—
1184652539
GROUP TAX ID
OH
05
—
2131633
—
OH
01
—
9934723
GROUP PTAN
OH
Enumeration date
06/16/2005
Last updated
07/21/2022
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