Individual
GREGORY JAMES STATEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
4421 ROOSEVELT BLVD, MIDDLETOWN, OH 45044-9023
(833) 510-4357
Mailing address
4600 MONTGOMERY RD STE 400, CINCINNATI, OH 45212-2600
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50.001631RX
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0085239
—
OH
Enumeration date
01/05/2006
Last updated
11/28/2023
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