Individual
JEFFERY REYNOLD KONTAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1740 CLEVELAND RD, WOOSTER, OH 44691-2204
(330) 287-4918
(330) 287-4802
Mailing address
1740 CLEVELAND RD, CLEVELAND CLINIC FHC WOOSTER, WOOSTER, OH 44691-2204
(330) 287-4918
(330) 287-4802
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35055953K
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000193119
ANTHEM
OH
05
—
0713786
—
OH
Enumeration date
11/03/2005
Last updated
08/18/2011
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