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Individual

JACOB A NYSATHER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DO

Contact information

Practice address
9275 MONTGOMERY RD, MONTGOMERY, OH 45242-7779
(513) 475-8525
(513) 936-4511
Mailing address
PO BOX 636256, CINCINNATI, OH 45263-6256
(513) 585-6200
(513) 245-3672

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
0116030769
VA
207RN0300X
Nephrology Physician
Primary
34.015521
OH
208M00000X
Hospitalist Physician
34.015521
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0462231
OH
Enumeration date
06/21/2017
Last updated
03/06/2023
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