Individual
JASON DEREK THOBURN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4998 W BROAD ST STE 104, COLUMBUS, OH 43228-1647
(888) 890-3779
Mailing address
731 CANONBY PL APT A, COLUMBUS, OH 43223-2379
(614) 674-0740
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
PRS.007823
OH
Other
Enumeration date
05/16/2026
Last updated
05/16/2026
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